Intramedullary cervical abscess in the setting of aortic valve endocarditis

摘要

Abstract Spinal cord tissue has a remarkable resistance to infection. An intramedullary abscess is an exceptional complication of infective endocarditis in the post-antibiotic era. We describe the case of a 42-year-old man who presented with fever and cephalea. Two days later, left-side numbness, lack of sphincter control, and a new aortic murmur were noticed. Magnetic resonance imaging demonstrated an 8x15-mm intramedullary cervical abscess. Transesophageal echocardiography revealed an aortic valve perforation as a result of infective endocarditis. Conservative management was decided for the intramedullary abscess. The development of an intramedullary abscess is an exceptional complication of infective endocarditis in the post-antibiotic era. Embolic involvement of the spinal cord is especially rare after bacteriemia. Normal spinal cord tissue has a remarkably high resistance to infection. Hematogenous spread is considered to be the common infection mechanism. We describe a case of intramedullary cervical abscess in the setting of aortic valve endocarditis. A 42-year-old previously healthy man presented to the emergency department with fever and cephalea. He had a history of lethargy and vomiting for the previous 5 days. Due to his symptoms on admission, bacterial meningitis was suspected. After blood cultures and a lumbar puncture, treatment with intravenous ceftriax-one 2 g twice daily and intravenous vancomycin 1 g twice daily was promptly established. In spite of the antibiotic therapy, left-side numbness and lack of sphincter control appeared 2 days later. Signs of acute pulmonary edema were rapidly established, and a new aortic diastolic murmur, not reported on admission, was detected on physical examination.