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Case 24

Staphylococcal osteomyelitis with epidural abscess

A 56 year old man with falls

This 56 year old man had a five year history of Parkinson's disease. Six months earlier he had been treated for septicaemia, and had made a full recovery.

Over recent weeks he had suffered an increasing number of falls. He was admitted and again found to be septicaemic, for which he was treated. However he also complained of pain in the groin, and was noted to have bilateral weakness and spasticity of the legs.

Investigations revealed a lytic bone lesion in the right superior pubic ramus. However X-rays of the spine were reported to show only some degenerative change in the cervical region.

An MRI of the spine was obtained to investigate his leg weakness.

Further images were obtained following contrast.

Findings

The T1 weighted image shows reduced signal from the marrow of the C6 and C7 vertebral bodies, with narrowing of the C6/7 intervertebral disc. There is additional soft tissue posteriorly which impinges on the cord.

The post contrast images demonstrate marked enhancement of the marrow of the affected vertebral bodies, and also of the posterior extension.

Diagnosis

Staphylococcal osteomyelitis with epidural abscess

Discussion

At surgery an epidural abscess was identified and drained. Staphylococcus aureus was isolated from the abscess and from the blood.

The lytic lesion in the pelvis was felt to be another site of osteomyelitis secondary to haematogenous dissemination of the infection.

Vertebral osteomyelitis is frequently secondary to haematogenous spread from urine infections, GU surgery, instrumentation and in diabetics, particularly in the elderly. Staphylococcus and streptococcus are common organisms. The abnormality is often centred on the disc, and affects the vertebrae either side, unlike metastases which are centred on the vertebral body, and which may also be visible in other vertebrae.

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