A unique case of metastatic spinal epidural abscess associated with liver abscess following ascending cholangitis and Escherichia coli bacteremia

Main Article Content

Nour Karra
Samer Ganam
Amitai Bickel
Maxim Bez
Ibrahim Abu Shakra
Doron Fischer
Eli Kakiashvili

Abstract

Pyogenic liver abscess (PLA) is a life-threatening infection that may develop as a result of an underlying hepatobiliary disease. A possible complication of PLA is metastatic spread, resulting in distant seeding of infection in other organs, and occasionally in the epidural space. Spinal epidural abscess (SEA) is a rare infection with severe potential complications. We describe a 71-year-old patient who presented with ascending cholangitis that was complicated by micro PLA, with a subsequent Escherichia coli bacteremia and metastatic SEA. An emergent surgical intervention with laminotomy and drainage of the epidural collection was performed. The patient was treated with a prolonged antibiotic regimen, with uneventful recovery and no neurologic sequelae. To our knowledge, this is the first reported case of a SEA following E. coli PLA.

Article Details

Karra, N., Ganam, S., Bickel, A., Bez, M., Shakra, I. A., Fischer, D., & Kakiashvili, E. (2019). A unique case of metastatic spinal epidural abscess associated with liver abscess following ascending cholangitis and Escherichia coli bacteremia. Archives of Surgery and Clinical Research, 3(2), 072. https://doi.org/10.29328/journal.ascr.1001039
Case Reports

Copyright (c) 2019 Karra N, et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Vakili M, Crum-Cianflone NF. Spinal Epidural Abscess: A Series of 101 Cases. Am J Med. 2017; 130: 1458-1463. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28797646

Darouiche RO. Spinal Epidural Abscess. N Engl J Med. 2006; 355: 2012-2020. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17093252

Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore). 1992; 71: 369-385. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1359381

Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000; 23: 175-205. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11153548

Kapeller P, Fazekas F, Krametter D, Koch M, Roob G, et al. Pyogenic infectious spondylitis: clinical, laboratory and MRI features. Eur Neurol. 1997; 38: 94-98. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9286631

Mohsen AH, Green ST, Read RC, McKendrick MW. Liver abscess in adults: ten years' experience in a UK centre. QJM. 2002; 95: 797-802. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12454322

Shi SH, Feng XN, Lai MC, Kong HS, Zheng SS. Biliary diseases as main causes of pyogenic liver abscess caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Liver International. 2017; 37: 727-734. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27718321

Thomsen RW, Jepsen P, Sørensen HT. Diabetes mellitus and pyogenic liver abscess: risk and prognosis. Clin Infect Dis. 2007; 44: 1194-1201. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17407038

Chan KS, Chen CM, Cheng KC, Hou CC, Lin HJ, et al. Pyogenic liver abscess: a retrospective analysis of 107 patients during a 3-year period. Jpn J Infect Dis. 2005; 58: 366-368. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16377869

Lin HF, Liao KF, Chang CM, Lin CL, Lai SW. Correlation between proton pump inhibitors and risk of pyogenic liver abscess. Eur J Clin Pharmacol. 2017; 73: 1019-1025. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28434021

Johannsen EC, Sifri CD, Madoff LC. Pyogenic liver abscesses. Infect Dis Clin North Am. 2000; 14: 547-563. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10987109

Lazarchick J, DeSouza NA, Nichols DR, Washington II JA. Pyogenic liver abscess. Mayo Clin Proc 1973; 48: 349-355. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/4703302

Pope JV, Teich DL, Clardy P, McGillicuddy DC. Klebsiella pneumoniae liver abscess: an emerging problem in North America. J Emerg Med. 2011; 41: e103-e105. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18993020

Leederman E, Crum N. Pyogenic liver abscess with a focus on klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. Am J Gastroenterol. 2005; 100: 322-331. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15667489

Keller JJ, Tsai MC, Lin CC, Lin YC, Lin HC. Risk of infections subsequent to pyogenic liver abscess: a nationwide population-based study. Clin Microbiol Infect. 2013; 19: 717-722. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23034092

Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, et al. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis. 2007; 45: 284-293. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17599305

Kuramochi G, Takei S, Sato M, Isokawa O, Takemae T, et al. Klebsiella pneumoniae liver abscess associated with septic spinal epidural abscess. Hepatol Res. 2005; 31: 48-52. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15652471

Hsieh MJ, Lu TC, Ma MH M, Wang HP, Chen SC. Unrecognized cervical spinal epidural abscess associated with metastatic klebsiella pneumoniae bacteremia and liver abscess in non-diabetic patients. Diagn Microbiol Infect Dis 2009; 65: 65-68. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19679238

O'Neill SC, Baker JF, Ellanti P, Synnott K. Cervical epidural abscess following an Escherichia coli urinary tract infection. BMJ Case Rep. 2014. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24473426

Moustafa A, Kheireldine R, Khan Z, Alim H, Khan MS, et al. Cervical Spinal Osteomyelitis with Epidural Abscess following an Escherichia coli Urinary Tract Infection in an Immunocompetent Host. Case Rep Infect Dis. 2019; 2019: 5286726. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31143482

Halvorsen RA, Korobkin M, Foster WL, Silverman PM, Thompson WM. The variable CT appearance of hepatic abscesses. Am J Roentgenol. 1984; 142: 941-946. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/6372412

Wang N, Ju Y, Wu J, Liu A, Chen A, et al. Differentiation of liver abscess from liver metastasis using dual-energy spectral CT quantitative parameters. Eur J Radiol. 2019; 113: 204-208. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30927948

Choi SY, Kim KY, Min JH, Cha DI, Jeong WK, et al. The value of gadoxetic acid-enhanced MRI for di?erentiation between hepatic microabscesses and metastases in patients with periampullary cancer, Eur. Radiol. 2017; 27: 4383-4393. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28342102

Alsaif HS, Venkatesh SK, Chan DS, Archuleta S. CT appearance of pyogenic liver abscesses caused by Klebsiella pneumoniae. Radiology. 2011; 260: 129-138. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21460028

Syed MA, Kim TK, Jang HJ. Portal and hepatic vein thrombosis in liver abscess: CT findings. Eur J Radiol. 2007; 61: 513-519. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17161932

Wang YF, Chang CC, Lee TC, Shih IL, Lien WC, et al. Recent trend of pylephlebitis in Taiwan: Klebsiella pneumoniae liver abscess as an emerging etiology. Infection. 2013; 41: 1137-1143. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23817997

Molton JS, Chee YL, Hennedige TP, Venkatesh SK, Archuleta S. Impact of Regional Vein Thrombosis in Patients with Klebsiella pneumoniae Liver Abscess. PLoS One. 2015; 10: e0140129. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26444702

Heusner AP. Nontuberculous spinal epidural infections. N Engl J Med. 1948; 239: 845-854. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18894306