Vertebral osteomyelitis and epidural abscess caused by gas gangrene presenting with complete paraplegia: a case report

Abstract

Introduction: Gas gangrene is most often caused by Clostridium perfringens infection. Gas gangrene is a medical emergency that develops suddenly. The mortality rate is higher with trunk involvement than with involvement of the extremities, which carries a better prognosis. With respect to vertebral involvement, there are few reports in the literature. The purpose of this paper is to report a very rare case of vertebral osteomyelitis caused by gas gangrene.

Case presentation: A 78-year-old Japanese woman with diabetes mellitus was admitted to our hospital with the chief complaints of back pain, dysuria, and complete paralysis of both legs. A computed tomography scan showed soft tissue swelling anterolaterally at intervertebral disc level T11/12 and a gas-containing epidural abscess that compressed her spinal cord. Cultures later grew Clostridium perfringens and Escherichia coli. Hemilaminectomy was done from T10 to T12, and an epidural abscess was removed. She went on to have fusion surgery 6 weeks after the initial operation and subsequently experienced complete pain relief. She was discharged 2 months later, at which time she was able to walk with a cane. Examination 18 months after surgery showed normal gait without a cane.

Conclusions: Discitis caused by gas gangrene infection was successfully treated by immediate debridement and subsequent fusion surgery.

Figure 1

Computed tomography sagittal and axial images on initial admission. (a) Soft tissue swelling anterolaterally at intervertebral disc level T11/12 (b) and a gas-containing epidural abscess are seen.

Figure 2

Magnetic resonance imaging sagittal and axial images on initial admission. Involvement of the T11/12 disc space and adjacent vertebral body with decreased signal intensity on the T1-weighted images (a and c) and increased signal intensity on the T2-weighted images (b and d) with a gas-containing epidural abscess are seen.

Figure 3

Computed tomography at 6 weeks after operation. T12 vertebral bone destruction is seen.

Figure 4

Plain radiograph at 18 months after operation. Complete union between the T11 and T12 vertebral bodies is seen. Open arrow shows bone bridge between T11 and T12 vertebra. (a) Anteroposterior radiograph, (b) Lateral radiograph.