Neisseria gonorrhoeae paravertebral abscess

Case report

Sharon Y. Y. LowDepartment of Neurosurgery, National Neuroscience Institute;

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 M.B.B.S., M.R.C.S.(UK)
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Catherine W. M. OngDivision of Infectious Disease, Department of Medicine;

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 M.B.B.S., M.R.C.P.(UK)
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Po-Ren HsuehDivisions of Clinical Microbiology and Infectious Diseases, Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

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 M.D.
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Paul Ananth TambyahDivision of Infectious Disease, Department of Medicine;

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 M.D.
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Tseng Tsai YeoDivision of Neurosurgery, National University Health System, Singapore; and

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 M.B.B.S., F.R.A.C.S.(Neurosurg)
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The authors present the case of an isolated gonococcal paravertebral abscess with an epidural component in a 42-year-old man. A primary epidural abscess of the spine is a rare condition and is most commonly caused by Staphylococcus aureus. In this report, the authors present their therapeutic decisions and review the relevant literature on disseminated gonococcal infection in a patient presenting with an epidural abscess.

A 42-year-old Indonesian man was admitted with symptoms of neck and upper back pain and bilateral lower-limb weakness. Clinical examination was unremarkable apart from tenderness over the lower cervical spine. Postgadolinium T1-weighted MRI of the cervical and thoracic spine demonstrated an enhancing lesion in the right paraspinal and epidural soft tissue at C-6 to T1–2, in keeping with a spinal epidural abscess. The patient underwent laminectomy of C-7 and T-1 with abscess drainage. Tissue cultures subsequently grew Neisseria gonorrhoeae that was resistant to quinolones by genotyping. Upon further questioning, the patient admitted to unprotected sexual intercourse with commercial sex workers. Further investigations showed that he was negative for other sexually transmitted infections. Postoperatively, he received a course of beta-lactam antibiotics with good recovery. Clinicians should be aware of this unusual disseminated gonococcal infection manifested in any patient with the relevant risk factors.

Abbreviations used in this paper:

CRP = C-reactive protein; DGI = disseminated gonococcal infection; ESR = erythrocyte sedimentation rate; NAAT = nucleic acid amplification test; PEA = phenylethyl alcohol; STD = sexually transmitted disease.
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