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: Case report  Hong Kong

[In Press] A 60-Year-Old Man with Gingivitis and Poorly Controlled Diabetes Developing Low Back Pain 1 Week Following Recovery from COVID-19 Diagnosed with Spinal Abscess Due to Streptococcus oralis

Challenging differential diagnosis, Rare disease

Eric Chun-Pu Chu ORCID logo1ABCDE, Robert J. Trager ORCID logo2CDEF, Alan Te Chang Chen1ABCDE, John Sing Fai Shum3BCDE

Am J Case Rep In Press; DOI:   :: ID: 937517

Available online: , In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Streptococcus oralis (S. oralis) is a gram-positive bacterium and component of the oral microbiota that can rarely cause opportunistic infection in the immunosuppressed. This report presents a 60-year-old man from Hong Kong with gingivitis and poorly controlled diabetes who visited his chiropractor with low back pain 2 weeks following mild COVID-19 and was diagnosed with paraspinal, psoas, and epidural abscess due to S. oralis.
CASE REPORT
The patient tested positive for COVID-19 when asymptomatic, then had a mild 10-day course of the illness, followed by low back pain 1 week later, prompting him to visit his primary care provider, who diagnosed sciatica and treated him with opioid analgesics. He presented to a chiropractor the following week, noting severe low back pain with radiation into the gluteal regions and posterior thighs, difficulty with ambulation, and mild neck pain. Considering the patient’s diabetes, widespread symptoms, and weakness, the chiropractor ordered whole-spine magnetic resonance imaging, which suggested possible multifocal spinal abscess and referred him urgently to a spine surgeon. The surgeon conducted testing consistent with bacterial infection, and referred to an infectious disease specialist, who confirmed S. oralis spinal infection via lumbar paraspinal needle biopsy and culture. The patient was first treated with oral antibiotics, then intravenous antibiotics in a hospital. Over 4 weeks, his spinal pain improved, and laboratory markers of infection normalized.
CONCLUSIONS
This case illustrates an opportunistic pyogenic spinal infection including paraspinal, psoas, and epidural abscesses caused by S. oralis in an immunocompromised patient following COVID-19 illness.

Keywords: Back Pain; Chiropractic; COVID-19; Epidural Abscess; Psoas Abscess

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923