J Korean Med Sci.  2007 Apr;22(2):380-382. 10.3346/jkms.2007.22.2.380.

Eikenella Corrodens Cervical Spinal Epidural Abscess Induced by a Fish Bone

• Jeon SH
• Han DC
• Lee SG
• Park HM
• Shin DJ
• Lee YB

• KMID: 1713207
• DOI: http://doi.org/10.3346/jkms.2007.22.2.380

Abstract

Cervical spinal epidural abscess, caused by fish bone injury and a secondary infection by Eikenella corrodens which is part of the normal flora, has not been reported. A 72-yr-old man came to the hospital with pain in his posterior neck and both shoulders for 2 months. He also was experiencing weakness on his right side for 3 days. A fish bone had been stuck in his throat for about 2 months. Neurological examination revealed right hemiparesis, hypesthesia on the left extremities and neck stiffness. Laboratory findings showed an elevated ESR/CRP and leukocytosis, and magnetic resonance imaging revealed a retropharyngeal abscess and cervical myelitis. The patient was treated with emergency surgical decompression and antibiotics. A fish bone was removed from the C3-C4 intervertebral disc space. In the culture of chocolate blood agar and 5% sheep blood agar plate, E. corrodens was detected as a causative organism.

Keyword

Eikenella Corrodens; Fish Bone; Spinal Epidural Abscess

MeSH Terms

Male
Humans
Gram-Negative Bacterial Infections/diagnosis/*etiology/prevention & control
Foreign Bodies/*complications/*surgery
Food/*adverse effects
Fishes
Epidural Abscess/diagnosis/*etiology/*surgery
Eikenella corrodens/*isolation & purification
Decompression, Surgical
Bone and Bones
Anti-Bacterial Agents/administration & dosage
Animals
Aged

Figure

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  Fig. 1 Cervical MRI. Note the retropharyngeal abscess with osteomyelitis of C3 and C4 vertebral bodies that was extending into the anterior and lateral epidural space (white arrows). Associated ischemic changes and edemas were also observed at the medulla oblongata, whole cervical spinal cord and upper thoracic spinal cord (black arrows).

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  Fig. 2 A skate bone. A 0.2×1.2 cm-sized skate bone was removed from the intervertebral disc space between 3rd and 4th cervical vertebral body.

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  Fig. 3 Cervical MRI (4 months later). Note the decrease of swelling and signal intensities of the retropharyngeal abscess, spondylitis (white arrows), and also spinal cord (black arrows) compared to the previous cervical MRI.

Reference

1. Tsai YS, Lui CC. Retropharyngeal and epidural abscess from a swallowed fish bone. Am J Emerg Med. 1997. 15:381–382.

2. Curling OD, Gower DJ, McWhorter JM. Changing concepts in spinal epidural abscess: a report of 29 cases. Neurosurgery. 1990. 27:185–192.

3. Heavy RJ, Vaccaro AR, Mesa JJ, Balderstone RA. Thoracolumbar infections in penetrating injuries to the spine. Orthop Clin North Am. 1996. 27:69–81.

4. Durity F, Thompson GB. Localized cervical extradural abscess: case report. J Neurosurg. 1968. 28:387–390.

5. Digby JM, Kersley JB. Pyogenic nontuberculous spine infection on analysis of 30 cases. J Bone Joint Surg Br. 1979. 61:47–55.

6. Berger S, Elidan J, Gay I. Retropharyngeal abscess caused by a traumatic perforation of the hypopharynx by a fish bone. Ann Otol Rhinol Laryngol. 1990. 99:927–928.

7. Har-El G, Aroesty JH, Shaha A, Lucente FE. Changing trends in deep neck abscess. A retrospective study of 110 patients. Oral Surg Oral Med Oral Pathol. 1994. 77:446–450.

8. Raab MG, Lutz RA, Stauffer ES. Eikenella corrodens vertebral osteomyelitis. A case report and literature review. Clin Orthop Relat Res. 1993. 293:144–147.

9. Nussbaum ES, Rigamonti D, Standiford H, Numagnchi Y, Wolf AL, Robinson WL. Spinal epidural abscess: a report 40 cases and review. Surg Neurol. 1992. 38:225–231.