J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://www.journalmc.org

Case Report

Volume 11, Number 12, December 2020, pages 417-425

Disseminated Spinal Epidural Abscess in an Immunocompetent Individual: A Case Report and Review of the Literature

Figure 1. Magnetic resonance imaging T2-weighted image in thoracic vertebrae. (a) Sagittal imaging on admission. A 0.5-mm-thick layer of spinal epidural fluid in the posterior epidural space in the whole thoracic region of the spinal cord, confirming a compressed epidural space (red arrow). (b) Axial imaging on admission. Similar findings to (a) are confirmed (red arrow). (c) Sagittal imaging, 30 days into antibiotics treatment. Findings in (a) have disappeared. (d) Axial imaging, 30 days into antibiotics treatment. Thickness of spinal epidural fluid in the posterior epidural space is reduced, and compression of the epidural space has improved.

Figure 2. Magnetic resonance imaging T2-weighted image in lumber and sacral vertebrae. (a) Sagittal imaging on admission. A 0.5-mm-thick layer of spinal epidural fluid in the anterior epidural space from the L5 to S2 vertebral body level region, confirming a compressed epidural space (red arrow). (b) Axial imaging on admission. Similar findings to (a) are not confirmed. (c) Sagittal imaging, 30 days into antibiotics treatment. Findings in (a) have disappeared. (d) Axial imaging, 30 days into antibiotics treatment. Findings in (a) are not confirmed.

**Table 1.** Routine Laboratory Examination on Admission
Parameter (units)	Measured value	Normal value
CLEIA: chemiluminescent enzyme immunoassay; PR3: proteinase 3; MPO: myeloperoxidase; Ig: immunoglobulin.
Blood
White blood cell (10³/µL)	13.5	3.8 - 8.5
Neutrophil (%)	81.6	48 - 61
Lymphocyte (%)	10.4	25 - 45
Monocyte (%)	7.9	4 - 7
Eosinophil (%)	0	1 - 5
Basophil (%)	0.1	0 - 1
Red blood cell (10⁶/µL)	4.76	3.78 - 4.97
Platelet (10³/µL)	222	131 - 365
Aspartate transaminase (IU/L)	20	12 - 31
Alanine aminotransferase (IU/L)	18	8 - 40
Lactic acid dehydrogenase (IU/L)	134	110 - 210
Gamma-glutamyl transpeptidase (IU/L)	29	9 - 49
Total bilirubin (mg/dL)	0.39	0.3 - 1.2
Total protein (g/dL)	6.9	6.7 - 8.3
Albumin (g/dL)	4.2	3.9 - 4.9
Creatine kinase (IU/L)	34	50 - 170
Blood urea nitrogen (mg/dL)	5.5	8 - 22
Creatinine (mg/dL)	0.81	0.4 - 0.8
Amylase (IU/L)	100	39 - 134
Sodium (mEq/L)	138	138 - 146
Potassium (mEq/L)	3.8	3.6 - 4.9
Chloride (mEq/L)	105	99 - 109
C-reactive protein (mg/dL)	10.98	0 - 0.4
Procalcitonin (ng/mL)	0.18	0 - 0.5
Hepatitis B surface antigen/CLEIA	(-)	(-)
Hepatitis C virus antibody	(-)	(-)
Treponema pallidum antibody	(-)	(-)
Rapid plasma reagin card agglutination test	(-)	(-)
Rheumatoid factor (IU/mL)	0	0 - 15
Thyroid-stimulating hormone (µIU/mL)	1.933	0.541 - 4.261
Triiodothyronine (pg/mL)	2.33	2.39 - 4.06
Thyroxin (ng/dL)	1.07	0.72 - 1.52
Activated partial thromboplastin time (s)	37.5	26.1 - 35.6
Prothrombin time (international normalized ratio)	1.23	0.8 - 1.18
Fibrinogen (mg/L)	677	200 - 400
Antithrombin III (%)	98	80 - 120
Fibrin degradation products (µg/mL)	4.9	0 - 10
D-dimer (µg/mL)	1.68	0 - 1
Erythrocyte sedimentation rate (mm/h)	64	3 - 15
Erythrocyte sedimentation rate (mm/2 h)	103	0 - 43
Human immunodeficiency virus-1, 2 antigen/antibody	(-)	(-)
IgE (IU/mL)	104	0 - 170
PR3-antineutrophil cytoplasmic antibody	(-)	(-)
MPO-antineutrophil cytoplasmic antibody	(-)	(-)
Soluble interleukin-2 receptor (U/mL)	409	122 - 496
Antinuclear antibody (times)	< 40	< 40
Anti-cardiolipin IgG (U/mL)	3	0 - 10
Lupus anticoagulant/PLI	0.81	0 - 1.16
Urine
Urobilinogen	(-)	(-)
Occult blood reaction	(-)	(-)
Protein	(-)	(-)
Sugar	(-)	(-)
pH	8	5 - 7.5
Ketone body	(-)	(-)
Bilirubin	(-)	(-)
Nitrite	(-)	(-)
White blood cells	(-)	(-)
Streptococcus pneumoniae	(-)	(-)
Legionella pneumoniae	(-)	(-)
Pregnant reaction	(-)
Flu A	(-)	(-)
Flu B	(-)	(-)
Mycoplasma pneumoniae antigen	(-)	(-)
Cerebrospinal fluid
Red blood cell number (/µL)	0
Cell number (/µL)	2
Mononuclear cell (%)	50
Polymorphonuclear cell (%)	50
Pandy reaction	(-)
Protein (mg/dL)	34.1
Sugar (mg/dL)	57
Potassium (mEq/L)	2.6
Chloride (mEq/L)	122.9

Table 1. Routine Laboratory Examination on Admission

Parameter (units)

Measured value

Normal value

CLEIA: chemiluminescent enzyme immunoassay; PR3: proteinase 3; MPO: myeloperoxidase; Ig: immunoglobulin.

Blood

White blood cell (10³/µL)

13.5

3.8 - 8.5

Neutrophil (%)

81.6

48 - 61

Lymphocyte (%)

10.4

25 - 45

Monocyte (%)

7.9

4 - 7

Eosinophil (%)

1 - 5

Basophil (%)

0.1

0 - 1

Red blood cell (10⁶/µL)

4.76

3.78 - 4.97

Platelet (10³/µL)

222

131 - 365

Aspartate transaminase (IU/L)

12 - 31

Alanine aminotransferase (IU/L)

8 - 40

Lactic acid dehydrogenase (IU/L)

134

110 - 210

Gamma-glutamyl transpeptidase (IU/L)

9 - 49

Total bilirubin (mg/dL)

0.39

0.3 - 1.2

Total protein (g/dL)

6.9

6.7 - 8.3

Albumin (g/dL)

4.2

3.9 - 4.9

Creatine kinase (IU/L)

50 - 170

Blood urea nitrogen (mg/dL)

5.5

8 - 22

Creatinine (mg/dL)

0.81

0.4 - 0.8

Amylase (IU/L)

100

39 - 134

Sodium (mEq/L)

138

138 - 146

Potassium (mEq/L)

3.8

3.6 - 4.9

Chloride (mEq/L)

105

99 - 109

C-reactive protein (mg/dL)

10.98

0 - 0.4

Procalcitonin (ng/mL)

0.18

0 - 0.5

Hepatitis B surface antigen/CLEIA

(-)

Hepatitis C virus antibody

(-)

Treponema pallidum antibody

(-)

Rapid plasma reagin card agglutination test

(-)

Rheumatoid factor (IU/mL)

0 - 15

Thyroid-stimulating hormone (µIU/mL)

1.933

0.541 - 4.261

Triiodothyronine (pg/mL)

2.33

2.39 - 4.06

Thyroxin (ng/dL)

1.07

0.72 - 1.52

Activated partial thromboplastin time (s)

37.5

26.1 - 35.6

Prothrombin time (international normalized ratio)

1.23

0.8 - 1.18

Fibrinogen (mg/L)

677

200 - 400

Antithrombin III (%)

80 - 120

Fibrin degradation products (µg/mL)

4.9

0 - 10

D-dimer (µg/mL)

1.68

0 - 1

Erythrocyte sedimentation rate (mm/h)

3 - 15

Erythrocyte sedimentation rate (mm/2 h)

103

0 - 43

Human immunodeficiency virus-1, 2 antigen/antibody

(-)

IgE (IU/mL)

104

0 - 170

PR3-antineutrophil cytoplasmic antibody

(-)

MPO-antineutrophil cytoplasmic antibody

(-)

Soluble interleukin-2 receptor (U/mL)

409

122 - 496

Antinuclear antibody (times)

< 40

Anti-cardiolipin IgG (U/mL)

0 - 10

Lupus anticoagulant/PLI

0.81

0 - 1.16

Urine

Urobilinogen

(-)

Occult blood reaction

(-)

Protein

(-)

Sugar

(-)

5 - 7.5

Ketone body

(-)

Bilirubin

(-)

Nitrite

(-)

White blood cells

(-)

Streptococcus pneumoniae

(-)

Legionella pneumoniae

(-)

Pregnant reaction

(-)

Flu A

(-)

Flu B

(-)

Mycoplasma pneumoniae antigen

(-)

Cerebrospinal fluid

Red blood cell number (/µL)

Cell number (/µL)

Mononuclear cell (%)

Polymorphonuclear cell (%)

Pandy reaction

(-)

Protein (mg/dL)

34.1

Sugar (mg/dL)

Potassium (mEq/L)

2.6

Chloride (mEq/L)

122.9