Introduction
Cervical spinal epidural abscess(SEA) is a rare and potentially life-altering disorder.
The incidence of SEA is as low as 0.2 to 1.2 per 10,000 inpatients, but is often associated with irreversible neurologic dysfunction and a higher risk of morbidity and mortality if not treated promptly.
In this article, we report a case of a young and healthy patient with cervical spinal epidural abscess, which worsened after bee venom acupuncture and resulted in sepsis.
Case Report
A 36-year-old man was referred to our hospital due to neck pain, fever and motor weakness. He had no specific medical history and that he did not have any discomfort in the neck and shoulder region previously. He said that symptoms of neck pain and fever started after carrying an object that weighed about 20 kilograms. Initially, he did not take the symptom seriously. However, the pain suddenly worsened after receiving outpatient bee venom acupuncture on the neck at a local Korean medicine clinic. High fever persisted and the patient was admitted to another hospital. The following day, bilateral motor weakness of upper and lower extremities also occurred, making his condition far more complicated. Finally, he was transferred to our hospital.
On admission, he had fever and posterior neck pain. Neurological examination showed marked meningeal irritation signs such as neck stiffness, Brudzinski sign and Kernig sign and motor weakness, Medical Research Council(MRC) grade IV in all limbs. Hematological examination revealed elevated white blood cell count(17,100/mm3) and apparent inflammatory reactions(erythrocyte sedimentation rate, 64mm/hr; C-reactive protein, 45.3mg/dl). Magnetic resonance imaging(MRI) of the cervical spine revealed long segmental anterior epidural lesion from C2 to T2, compatible with an epidural abscess. Therefore, antibiotics was administered empirically.
On hospital day three, High flow nasal cannula(Optiflow) was applied due to sepsis. On day seven, the patient’s motor weakness was worsening to MRC grade II in his upper limbs. so MRI of the spine was performed. T2-weighted sagittal image showed aggravation of epidural abscess from C2 to T3 and osteomyelitis of C6,7 vertebral bodies.
The patient was treated with antibiotics continuously for six weeks. After the spinal infection was controlled, he was transferred to the rehabilitation department for comprehensive rehabilitation. The muscle strength of his upper and lower extremities gradually improved to MRC grade IV.
Conclusion
This is a case of cervical spinal epidural abscess that aggravated after bee venom acupuncture. Acupuncture on the cervical area had led the initial local skin infection to extend to epidural space and, in turn, to spread hematogenously.
We could recommend that acupuncture practitioners should pay attention to hygienic measures. |
