Spinal epidural abscess in a patient with Job Disease: Case Report and Review of Literature

Abstract

A spinal epidural abscess is a devastating, potentially life threatening condition that requires prompt diagnosis and treatment. Risk factors for epidural abscess include immune-compromised states such as cancer, acquired immunodeficiency syndromes, diabetes mellitus, chronic renal failure, alcoholism as well as spinal surgeries and procedures such as epidural anesthesia. The signs and symptoms of epidural abscess can present as low back pain, fever, spinal tenderness, radiating root pain followed by extremity weakness and sepsis. The most common causative organisms in spinal epidural abscess are methicillin-sensitive Staphylococcus aureus (MSSA), and methicillin-resistant Staphylococcus aureus (MRSA).                A combined medical-surgical approach, with emergent surgical decompression and drainage of purulent material, has been the recommended approach to spinal epidural abscess. Most patients essentially undergo surgical decompression followed by four to six weeks of antibiotic therapy Antibiotic-based therapy, sometimes combined with CT-directed needle aspiration for culture-proven diagnosis, may be appropriate in patients who are determined to be at a very high risk of surgery or who have a motor paralysis that lasted more than 48-72 hours.

Job's syndrome (hyperimmunoglobulin E syndrome) is a congenitally acquired primary immune deficiency. The immune defense defect in Job's syndrome is impaired phagocytosis. Patients with Job's syndrome have difficulties eradicating staphylococcal infections. A high-grade Staphylococcus aureus bacteremia may cause extensive metastatic septic complications manifested as brain abscess, epidural abscesses, and multifocal vertebral osteomyelitis. We report a 66 year-old gentleman diagnosed with Job Disease who presented with septicemia, clavicular osteomyelitis and quadriplegia secondary to a cervical epidural abscess. He was placed on renally adjusted Vancomycin and Cefazolin. Surgical decompression was not indicated secondary to the patient’s multiple comorbidities and the fact that he had lost his motor function for more than 72 hours before he presented.