A rare case of Streptobacillus moniliformis epidural abscess requiring neurosurgical decompression

Streptobacillus moniliformis is the primary causative agent of rat bite fever, an infectious disease transmitted through contact with rats through bites, scratches, or exposure to excrement. Before this report, only two instances of spinal epidural abscess (SEA) due to S. moniliformis infection have been documented. We present the case of a 76-year-old male who developed a cervical SEA secondary to S. moniliformis infection, requiring neurosurgical decompression of the spinal cord.

A 76-year-old male presented to the emergency department with bilateral shoulder and back pain, upper extremity weakness, left hip pain, and left thumb pain. He denied any recent exposure to pets or animals, and the initial workup did not yield the source of the infection. Enhanced magnetic resonance imaging of the cervical spine demonstrated C6-7 discitis/osteomyelitis and an associated ventral SEA, as well as discitis/osteomyelitis of the C2 vertebral body and C5-6 endplates. Subsequently, the patient underwent a C3-7 laminectomy and received a 6-week postoperative course of intravenous ceftriaxone, resulting in complete resolution of the abscess. Blood tests revealed the presence of S. moniliformis, which the patient attributed to potential rat exposure at his workplace.

Identification and diagnosis of S. moniliformis infection requires a high index of suspicion. Neurosurgeons should consider this rare pathogen in the differential diagnosis of SEA to facilitate early detection, diagnosis, and surgical intervention, ultimately improving patient outcomes.