Multilevel lumbar spine infection due to poor dentition in an immunocompetent adult: A case report

Michaela B. Quast, Carrie Carr, W. Michael Hooten

Research output: Contribution to journalArticle

Abstract

Background: Although spinal infections have been reported following dental procedures, development of a spinal infection attributed to poor dentition without a history of a dental procedure in an immunocompetent adult has not been previously reported. Here we provide a case report of a multilevel lumbar spine infection that developed in an immunocompetent adult with poor dentition. Case presentation: A 63-year-old white male man with past medical history of hypertension presented to a hospital emergency department with a 4-month history of progressively worsening low back pain. A musculoskeletal examination demonstrated diffuse tenderness in his lumbar spine area and the results of a neurological examination were within normal limits. Computed tomography and magnetic resonance imaging of his lumbar spine demonstrated a prevertebral and presacral fluid collection ventral to the L4 to L5 and L5 to S1 interspaces. Blood cultures grew pan-sensitive Streptococcus intermedius in four of four bottles within 45 hours. Using computed tomography guidance, three core biopsies of the L4 to L5 interspace were taken and subsequent cultures were positive for Streptococcus intermedius. He reported that his last episode of dental care occurred more than 20 years ago and a dental panoramic radiograph demonstrated significant necrotic dentition. Ten teeth were extracted and the necrotic dentition was assumed to be the most likely source of infection. On hospital dismissal, he received a 12-week course of intravenously administered ceftriaxone followed by an 8-week course of orally administered cefadroxil pending repeat imaging. Conclusions: This case report demonstrates the importance of determining the source of infection in a patient with a spontaneous spinal infection. Even in the absence of a recent dental procedure, dentition should be considered a possible source of infection in an immunocompetent patient who presents with a spontaneous spinal infection.

Original languageEnglish (US)
Article number328
JournalJournal of Medical Case Reports
Volume11
Issue number1
DOIs
StatePublished - Nov 22 2017

Fingerprint

Dentition
Spine
Tooth
Infection
Streptococcus intermedius
Cefadroxil
Tomography
Episode of Care
Dental Care
Ceftriaxone
Hospital Departments
Neurologic Examination
Low Back Pain
Hospital Emergency Service
Magnetic Resonance Imaging
Hypertension
Biopsy

Keywords

  • Dentition
  • Epidural abscess
  • Immunocompetent
  • Lumbar spine

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Multilevel lumbar spine infection due to poor dentition in an immunocompetent adult : A case report. / Quast, Michaela B.; Carr, Carrie; Hooten, W. Michael.

In: Journal of Medical Case Reports, Vol. 11, No. 1, 328, 22.11.2017.

Research output: Contribution to journalArticle

@article{a0204f02564145449eaead3865b0baa3,
title = "Multilevel lumbar spine infection due to poor dentition in an immunocompetent adult: A case report",
abstract = "Background: Although spinal infections have been reported following dental procedures, development of a spinal infection attributed to poor dentition without a history of a dental procedure in an immunocompetent adult has not been previously reported. Here we provide a case report of a multilevel lumbar spine infection that developed in an immunocompetent adult with poor dentition. Case presentation: A 63-year-old white male man with past medical history of hypertension presented to a hospital emergency department with a 4-month history of progressively worsening low back pain. A musculoskeletal examination demonstrated diffuse tenderness in his lumbar spine area and the results of a neurological examination were within normal limits. Computed tomography and magnetic resonance imaging of his lumbar spine demonstrated a prevertebral and presacral fluid collection ventral to the L4 to L5 and L5 to S1 interspaces. Blood cultures grew pan-sensitive Streptococcus intermedius in four of four bottles within 45 hours. Using computed tomography guidance, three core biopsies of the L4 to L5 interspace were taken and subsequent cultures were positive for Streptococcus intermedius. He reported that his last episode of dental care occurred more than 20 years ago and a dental panoramic radiograph demonstrated significant necrotic dentition. Ten teeth were extracted and the necrotic dentition was assumed to be the most likely source of infection. On hospital dismissal, he received a 12-week course of intravenously administered ceftriaxone followed by an 8-week course of orally administered cefadroxil pending repeat imaging. Conclusions: This case report demonstrates the importance of determining the source of infection in a patient with a spontaneous spinal infection. Even in the absence of a recent dental procedure, dentition should be considered a possible source of infection in an immunocompetent patient who presents with a spontaneous spinal infection.",
keywords = "Dentition, Epidural abscess, Immunocompetent, Lumbar spine",
author = "Quast, {Michaela B.} and Carrie Carr and Hooten, {W. Michael}",
year = "2017",
month = "11",
day = "22",
doi = "10.1186/s13256-017-1492-z",
language = "English (US)",
volume = "11",
journal = "Journal of Medical Case Reports",
issn = "1752-1947",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Multilevel lumbar spine infection due to poor dentition in an immunocompetent adult

T2 - A case report

AU - Quast, Michaela B.

AU - Carr, Carrie

AU - Hooten, W. Michael

PY - 2017/11/22

Y1 - 2017/11/22

N2 - Background: Although spinal infections have been reported following dental procedures, development of a spinal infection attributed to poor dentition without a history of a dental procedure in an immunocompetent adult has not been previously reported. Here we provide a case report of a multilevel lumbar spine infection that developed in an immunocompetent adult with poor dentition. Case presentation: A 63-year-old white male man with past medical history of hypertension presented to a hospital emergency department with a 4-month history of progressively worsening low back pain. A musculoskeletal examination demonstrated diffuse tenderness in his lumbar spine area and the results of a neurological examination were within normal limits. Computed tomography and magnetic resonance imaging of his lumbar spine demonstrated a prevertebral and presacral fluid collection ventral to the L4 to L5 and L5 to S1 interspaces. Blood cultures grew pan-sensitive Streptococcus intermedius in four of four bottles within 45 hours. Using computed tomography guidance, three core biopsies of the L4 to L5 interspace were taken and subsequent cultures were positive for Streptococcus intermedius. He reported that his last episode of dental care occurred more than 20 years ago and a dental panoramic radiograph demonstrated significant necrotic dentition. Ten teeth were extracted and the necrotic dentition was assumed to be the most likely source of infection. On hospital dismissal, he received a 12-week course of intravenously administered ceftriaxone followed by an 8-week course of orally administered cefadroxil pending repeat imaging. Conclusions: This case report demonstrates the importance of determining the source of infection in a patient with a spontaneous spinal infection. Even in the absence of a recent dental procedure, dentition should be considered a possible source of infection in an immunocompetent patient who presents with a spontaneous spinal infection.

AB - Background: Although spinal infections have been reported following dental procedures, development of a spinal infection attributed to poor dentition without a history of a dental procedure in an immunocompetent adult has not been previously reported. Here we provide a case report of a multilevel lumbar spine infection that developed in an immunocompetent adult with poor dentition. Case presentation: A 63-year-old white male man with past medical history of hypertension presented to a hospital emergency department with a 4-month history of progressively worsening low back pain. A musculoskeletal examination demonstrated diffuse tenderness in his lumbar spine area and the results of a neurological examination were within normal limits. Computed tomography and magnetic resonance imaging of his lumbar spine demonstrated a prevertebral and presacral fluid collection ventral to the L4 to L5 and L5 to S1 interspaces. Blood cultures grew pan-sensitive Streptococcus intermedius in four of four bottles within 45 hours. Using computed tomography guidance, three core biopsies of the L4 to L5 interspace were taken and subsequent cultures were positive for Streptococcus intermedius. He reported that his last episode of dental care occurred more than 20 years ago and a dental panoramic radiograph demonstrated significant necrotic dentition. Ten teeth were extracted and the necrotic dentition was assumed to be the most likely source of infection. On hospital dismissal, he received a 12-week course of intravenously administered ceftriaxone followed by an 8-week course of orally administered cefadroxil pending repeat imaging. Conclusions: This case report demonstrates the importance of determining the source of infection in a patient with a spontaneous spinal infection. Even in the absence of a recent dental procedure, dentition should be considered a possible source of infection in an immunocompetent patient who presents with a spontaneous spinal infection.

KW - Dentition

KW - Epidural abscess

KW - Immunocompetent

KW - Lumbar spine

UR - http://www.scopus.com/inward/record.url?scp=85034738193&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85034738193&partnerID=8YFLogxK

U2 - 10.1186/s13256-017-1492-z

DO - 10.1186/s13256-017-1492-z

M3 - Article

C2 - 29162118

AN - SCOPUS:85034738193

VL - 11

JO - Journal of Medical Case Reports

JF - Journal of Medical Case Reports

SN - 1752-1947

IS - 1

M1 - 328

ER -