A 57-year-old woman with a history of duodenal ulcer and smoking two cigarettes a day, without health controls.
She was admitted to the Emergency Department due to low back pain for one week, with fever and progressive quali-quantitative compromise of consciousness.
It was confusing and agitated, in Glasgow 14, tachy, normotensive and aphasia, with diffuse pain to abdominal palpation.
Laboratory tests showed leukocytosis of 21.900 per mm3, creatinine + neutrophils / 30, platelets 31.600 per mm3, CRP 315 mg / l (VN < 5), blood glucose 327 mg / dl, BUN 38 mg).
Prothrombin was 45%, TTPK 29 sec. etiology was more compromised, Glasgow 8, neck rigidity and positive Blumberg sign, so it was diagnosed in the Intensive Care Unit.
She received mechanical ventilation.
Computed axial tomography (CAT) of brain, thorax, abdomen and pelvis was performed.
Empirical antibiotic therapy was initiated for sepsis of study focus, with imipenem and vancomycin.
The onset of type 2 DM was observed and treated with crystalline insulin.
Brain CT showed no abnormalities.
CT scan of the abdomen and pelvis revealed images of emphysematous cyst, pneumoretroperitoneum and pneumorrachy.
The patient was evaluated by rheumatologists for suspicion of spondylodyscitis.
A lumbar puncture was performed, at a level far from spondylodyscitis, which gave rise to purulent, smelly cerebrospinal fluid (CSF).
Escherichia coli susceptible to multiple antibiotics was developed in hemocultive, urocultive and CSF cultures.
Antibiotic therapy was adjusted to cef­triaxone, ciprofloxacin and amikacin.
The Urology team defined emphysematous cyst management.
At the follow-up CT, four days later, less air was observed in the spinal canal, while the bladder was located in discal space L5-S1, for pso, and mild pleural effusion.
Neurological evaluation showed tetraplegia, hyperreflexia and Babinski present.
She suffered a brain abscess and an epidural accident. Magnetic resonance imaging (MRI) was performed, which revealed a probable bulbar abscess, epidural abscess of the cervical spine and lumbar abscess, and abscess of multiple spinal cord fractures2, 1.
The case was discussed by the Neurosurgery team, discarding the possibility of an intervention due to its high surgical risk.
She was treated for 7 days with dexamethasone for spinal cord involvement.
1.
The patient developed fever for several weeks, with negative blood cultures.
After 16 days of invasive mechanical ventilation was extubated, the patient was transferred to the ICU and then to the ward.
The suggestion of infectologists completed 28 days of treatment with ceftriaxone and switched to oral ciprofloxacin.
The patient remained afflicted with low inflammatory parameters.
It required drainage by puncture under CAT of the collection of the right psoas, whose culture was polymicrobial.
She presented neuropatic pain of difficult management, requiring pregabalin, amitriptyline, opioids and paracetamol.
There was a slow improvement in tetraplegia, achieving strength M3 in lower limbs and M4 in upper limbs at discharge.
A decrease in epidural abscesses was observed in the control MRI, with no evidence of plexus or root compression.
He completed 100 days of antibiotic therapy and was discharged in stable condition.
It is controlled in another city, and 11 months after discharge it remains stable, affliction, in rehabilitation of tetraparesis.
