[Spinal Epidural Abscess and Spondylodiscitis Following Crimean-Congo Hemorrhagic Fever: A Rare Post-Recovery...

Crimean-Congo hemorrhagic fever (CCHF) is a rare but severe viral hemorrhagic disease transmitted to humans through tick bites or contact with the blood, tissues or secretions of infected animals. CCHF can lead to widespread endothelial damage and immune dysfunction, resulting in severe hemorrhagic manifestations and various complications. Although the majority of patients recover without permanent sequelae, unexpected complications such as secondary bacterial infections may rarely occur during the acute phase or convalescence. In this report, the case of a 42-year-old female patient who developed spinal epidural abscess and lumbar spondylodiscitis following real-time polymerase chain reaction testing confirmed CCHF was presented. On the seventh day of illness, the patient admitted to our emergency department with persistent high fever, nausea, vomiting, anorexia, malaise, diffuse body pain, hematuria and vaginal bleeding. The patient’s past medical history was unremarkable except for a lumbar disc herniation surgery 10 years ago. Following recovery from the acute viral illness, the patient developed sudden and severe lower back pain, recurrent high-grade fever and progressive motor weakness in plantar flexion of the right ankle. On the 10th day of hospitalization, spinal magnetic resonance imaging revealed spondylodiscitis and a spinal epidural abscess at the L5-S1 level. The epidural abscess caused compression of the S1 nerve roots, correlating with her neurological symptoms. The patient underwent surgical intervention (abscess drainage and stabilization) by the department of neurosurgery. Growth of Staphylococcus aureus in the blood culture confirmed that the infection was of bacterial origin but since the operation was performed while under 10 days of antibiotic treatment, there was no bacterial growth in the abscess material taken during the surgery. The patient was treated with intravenous cefazolin at a dose of 1000 mg three times daily for six weeks. Clinical improvement was rapid and complete, with no residual neurological deficits. This rare complication is thought to be related to immunoparalysis following a cytokine storm induced by CCHF, predisposing the patient to opportunistic bacterial infections. While leukopenia was observed during the immunosuppressive phase, a subsequent rise in leukocyte counts during recovery unmasked the signs of infection. Additionally, the patient’s history of prior spinal surgery may have created a localized microvascular injury or hematoma, forming a favorable niche for bacterial proliferation. New symptoms in the convalescent phase of CCHF must be carefully evaluated. In patients presenting with spinal pain and progressive localized motor deficits, prompt imaging and advanced diagnostics are essential to ensure early recognition and treatment of rare but potentially serious complications.