[Pneumococcal disease without apparent pulmonary involvement]

Spinal epidural abscess (SEA) is a classically monomicrobial infection most commonly caused by Staphylococcus aureus (∼65%), followed by Gram-negative bacilli (∼16%), and less frequently by Gram-positive diplococci such as Streptococcus pneumoniae (∼7%), which typically reach the epidural space hematogenously from another focus, mainly respiratory. SEA can originate from hematogenous seeding or direct inoculation, and in approximately one-third of cases, the source of infection cannot be identified. We present a clinical case of SEA associated with pneumococcal bacteremia. A 65-year-old woman with no relevant medical history presented with a 48-hour history of right-sided lower back pain, rendering her unable to sit or stand, with radiation to the thigh and associated fever. A contrast-enhanced magnetic resonance imaging of the spine revealed 5 and 6 mm collections in the posterior epidural space at the L4 and L5 levels. Blood cultures grew multi-sensitive S. pneumoniae, prompting initiation of antibiotic therapy with good clinical response. The traumatology team assessed the patient and obtained a sample from the larger collection, which also yielded the same pathogen. Isolated pneumococcal spinal infection is a rare but extremely serious condition, with a mortality rate exceeding 20%, and can lead to significant neurological consequences if not managed through a multidisciplinary approach involving broad-spectrum antibiotics and, in some cases, surgical intervention.