Spinal epidural abscess in COVID-19 patients

Area of Science:

• Neurology
• Infectious Diseases
• Neurosurgery

Background:

• Spinal epidural abscess (SEA) is typically secondary to other infections or procedures.
• Primary SEA, without an obvious source, is exceptionally rare.
• The association between COVID-19 and SEA has not been previously reported.

Purpose of the Study:

• To describe the unusual occurrence of primary spinal epidural abscess in patients with COVID-19.
• To investigate potential mechanisms linking SARS-CoV-2 infection to SEA development.

Main Methods:

• Retrospective review of six consecutive COVID-19 patients with primary SEA.
• Surgical management and analysis of clinical data, viral infection, and abscess characteristics.

Main Results:

• All six patients presented with primary SEA, a rare presentation.
• SEA occurred irrespective of COVID-19 severity, immune status, or bacteremia.
• Obesity and hypertension were noted risk factors; cervical and thoracic locations were common.
• Mild lymphopenia was observed in all patients.

Conclusions:

• The study highlights a potential association between COVID-19 and primary SEA.
• Hypothesized mechanism involves COVID-19-related endotheliitis facilitating retrograde bacterial invasion.
• Early diagnosis and treatment of SEA are critical due to high morbidity and mortality, especially in COVID-19 patients.