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[Prevertebral abscesses with a protracted insidious clinical course and subsequent lethal, acute pyogenic meningitis
Abstract:
This report concerns a 66-year-old man suffering from prevertebral abscesses with a protracted insidious clinical course and subsequent lethal and acute pyogenic meningitis. The patient had a three-month history of mild neck pain, and died as a result of septic shock due to staphylococcus aureus (methicillin susceptible) infection two days after admission to the hospital. At autopsy, abscesses encapsulated by fibrous connective tissue were found on the ventral surfaces of the cervical and thoracic regions of the spine. The prevertebral abscess on the upper cervical region was organized with dense fibrous tissue and contained a small number of inflammatory cells. On the other hand, the prevertebral abscess on the thoracic region was purulent and contained numerous inflammatory cells, macrophages and gram-positive cocci. Pyogenic spondylitis and discitis accompanying the prevertebral abscesses were multiple and widespread. These features suggested that the abscesses developed initially on the cervical region, extended caudally through the prevertebral space, directly involving the corpus vertebrae and discs, and ultimately caused sepsis. It is important to note that prevertebral abscesses can exhibit a protracted clinical course with only mild symptom such as minor neck pain and then manifest abruptly as acute meningitis and sepsis.
Insights
This case report details a fatal case of prevertebral abscesses leading to Staphylococcus aureus meningitis and septic shock. It highlights how these spinal infections can present insidiously before rapidly becoming life-threatening.
Area of Science:
- Spinal infections
- Infectious diseases
- Pathology
Background:
- Prevertebral abscesses are collections of pus in the space anterior to the cervical and thoracic spine.
- They can arise from various sources, including vertebral osteomyelitis or esophageal perforation.
- A protracted and insidious clinical course is often characteristic.
Observation:
- A 66-year-old male presented with a three-month history of mild neck pain.
- Despite initial mild symptoms, the patient rapidly deteriorated, developing acute pyogenic meningitis and septic shock.
- Autopsy revealed extensive prevertebral abscesses involving the cervical and thoracic spine, with associated spondylitis and discitis.
Findings:
- Cervical prevertebral abscess showed dense fibrous encapsulation with few inflammatory cells.
- Thoracic prevertebral abscess was purulent, containing numerous inflammatory cells, macrophages, and Staphylococcus aureus (methicillin-susceptible).
- The findings suggest a caudal extension of infection from the cervical to the thoracic spine, leading to sepsis.
Implications:
- Prevertebral abscesses can have a prolonged, subtle presentation before acute, severe complications like meningitis and sepsis emerge.
- Early recognition and prompt treatment are crucial for managing prevertebral abscesses to prevent catastrophic outcomes.
- This case underscores the importance of considering spinal infections in patients with persistent neck pain, even with mild initial symptoms.