[Cervical spinal epidural abscess caused by methicillin-resistant Staphylococcus aureus (MRSA)]

Epidural abscess is an uncommon infectious disease. The cervical spine is the least frequent site of spinal epidural abscess. It has been reported that early diagnosis and surgical treatment prevent neurological deficit, but it is difficult to diagnose this disease clinically. We presented a rare case of cervical epidural abscess caused by MRSA. A 54-year-old man was admitted to our hospital because of acute renal failure and hepatitis. He was treated with hemodialysis via the femoral route. His renal function recovered but high fever continued. MRSA was identified from the AV shunt catheter. He noted pain and dysesthesia on his left shoulder one month after admission. He was transferred to our department with suspect of spinal tumor. Neurological examination demonstrated left hemiparesis with superficial sensory disturbance between C8 and Th2. Cervical CT scan showed osteomyelitis at the left C7 lamina and facet. MR imaging disclosed that an epidural mass at C7 had low signal intensity on T1 weighted and high signal intensity on T2 weighted and ring-like enhancement with gadolinium. He was treated conservatively for a month. Sequential MR imaging showed the mass had homogeneous enhancement at C7 epidural space extending to the left intervertebral foramen. Laboratory examination showed normal. The patient was diagnosed as having cervical epidural abscess. A C6 through Th2 laminectomy and C8 foraminotomy were performed and an encapsulated abscess including yellowish pus was totally removed. The pathological diagnosis was non-specific abscess in the subacute stage. MRSA was identified by the intraoperative pus culture. After the surgery, antibiotics were administered.(ABSTRACT TRUNCATED AT 250 WORDS)