Karishma
An epidural collection due to streptococci agalactiae
Journal title : Yemen Journal of Medicine
Publisher : Mansa STM Publishers
Online ISSN : 2583-4614
Page Number : 52
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An Indonesian lady aged 52 years old presented to the emergency department with a 2-week history of lower backache. One-week later, she developed urine retention followed by bilateral lower limb weakness, and since then, she has been unable to walk. Her medical history, family history, and social history were unremarkable. She has no previous history of trauma or similar presented symptoms. Clinical examination showed spastic paraparesis with hyperreflexia. Blood chemistry showed HbA1c of 11.6, and the fasting blood glucose was 14.2 mmol/l. Contrast-enhanced magnetic resonance imaging (MRI) showed an epidural collection extending from T9 to S1 and occupying predominantly the anterior epidural space, with extension toward the posterior epidural space in the lumbosacral region (Fig. 1a). The provisional diagnosis was Pott’s disease, and lumbar (L) hemilaminectomy at L2 was done to drain the epidural collection. Mycobacterium tuberculosis was not detected by acid-fast bacilli or polymerase chain reaction testing of the specimen. However, the drained epdural collection was positive for penicillin-susceptible streptococci Agalactiae. Blood cultures were negative, and transesophageal echocardiography did not show any vegetations. The patient received intravenous ampicillin for 2 weeks, then switched to oral antibiotics for another 6 weeks, and was referred to the rehabilitation center, where she improved and was discharged after 8 weeks with a walker. A repeat MRI (Fig. 1b) showed a complete resolution of the previously described epidural collection.
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DOI : https://doi.org/10.32677/yjm.v1i1.3422
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