Actinomycosis as a very rare cause of thoracic spinal cord compression

Clinical note

Research output: Contribution to journalArticle

Abstract

Objective: To highlight the rare presentation of spinal cord compression due to actinomycosis. Materials and methods: We report a case of spinal cord compression caused by Actinomyces israelii in a 42 year-old Malay gentleman, who presented with gradual onset of bilateral lower limb weakness and difficulty in passing urine for 3 months. He had no history of trauma to the spine or other medical illness. However, he had history of chronic cough for more than 6 weeks and weight loss of about 15 kg within 3 months. On physical examination, his neurological level was T12 ASIA Impairment Scale B. Laboratory tests indicated leukocytosis and raised C Reactive Protein level. Results: Computed Tomography Scan of the thorax and abdomen showed paraspinal mass at thoracic (T2-9) region. CT guided biopsy was done and HPE results showed inflammation with actinomyces infection. Treatment with Intravenous (IV) Crystalline penicillin 4 mega unit q.i.d. was started and planned to continue for 4 weeks, followed by oral Penicillin 6-12 months. After 1 week of IV antibiotics, white cell count and C Reactive Protein level reduced to 50% of pre-treatment levels. Unfortunately, there was no improvement in neurology. Decompression and spinal fixation was offered but patient refused and opted for conservative management. Conclusion: This case report highlights the rare presentation of cord compression due to actinomycosis of thoracic spine, wherein the importance of biopsy obviously precedes clinical and radiological diagnosis.

Original languageEnglish
Pages (from-to)356-358
Number of pages3
JournalInternational Medical Journal
Volume19
Issue number4
Publication statusPublished - Dec 2012

Fingerprint

Actinomycosis
Spinal Cord Compression
Thorax
Penicillins
C-Reactive Protein
Spine
Biopsy
Actinomyces
Leukocytosis
Neurology
Decompression
Cough
Abdomen
Physical Examination
Weight Loss
Lower Extremity
Cell Count
Tomography
Urine
Anti-Bacterial Agents

Keywords

  • Actinomycosis
  • Paraplegia
  • Spinal cord compression
  • Spinal infection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{8d26068346994d3eb9008dc72e43eced,
title = "Actinomycosis as a very rare cause of thoracic spinal cord compression: Clinical note",
abstract = "Objective: To highlight the rare presentation of spinal cord compression due to actinomycosis. Materials and methods: We report a case of spinal cord compression caused by Actinomyces israelii in a 42 year-old Malay gentleman, who presented with gradual onset of bilateral lower limb weakness and difficulty in passing urine for 3 months. He had no history of trauma to the spine or other medical illness. However, he had history of chronic cough for more than 6 weeks and weight loss of about 15 kg within 3 months. On physical examination, his neurological level was T12 ASIA Impairment Scale B. Laboratory tests indicated leukocytosis and raised C Reactive Protein level. Results: Computed Tomography Scan of the thorax and abdomen showed paraspinal mass at thoracic (T2-9) region. CT guided biopsy was done and HPE results showed inflammation with actinomyces infection. Treatment with Intravenous (IV) Crystalline penicillin 4 mega unit q.i.d. was started and planned to continue for 4 weeks, followed by oral Penicillin 6-12 months. After 1 week of IV antibiotics, white cell count and C Reactive Protein level reduced to 50{\%} of pre-treatment levels. Unfortunately, there was no improvement in neurology. Decompression and spinal fixation was offered but patient refused and opted for conservative management. Conclusion: This case report highlights the rare presentation of cord compression due to actinomycosis of thoracic spine, wherein the importance of biopsy obviously precedes clinical and radiological diagnosis.",
keywords = "Actinomycosis, Paraplegia, Spinal cord compression, Spinal infection",
author = "Ohnmar Htwe and {Iqbal Hussain}, Rizuana and Saremi Nasim and {Selvi Naicker}, Amaramalar",
year = "2012",
month = "12",
language = "English",
volume = "19",
pages = "356--358",
journal = "International Medical Journal",
issn = "1341-2051",
publisher = "Japan International Cultural Exchange Foundation",
number = "4",

}

TY - JOUR

T1 - Actinomycosis as a very rare cause of thoracic spinal cord compression

T2 - Clinical note

AU - Htwe, Ohnmar

AU - Iqbal Hussain, Rizuana

AU - Nasim, Saremi

AU - Selvi Naicker, Amaramalar

PY - 2012/12

Y1 - 2012/12

N2 - Objective: To highlight the rare presentation of spinal cord compression due to actinomycosis. Materials and methods: We report a case of spinal cord compression caused by Actinomyces israelii in a 42 year-old Malay gentleman, who presented with gradual onset of bilateral lower limb weakness and difficulty in passing urine for 3 months. He had no history of trauma to the spine or other medical illness. However, he had history of chronic cough for more than 6 weeks and weight loss of about 15 kg within 3 months. On physical examination, his neurological level was T12 ASIA Impairment Scale B. Laboratory tests indicated leukocytosis and raised C Reactive Protein level. Results: Computed Tomography Scan of the thorax and abdomen showed paraspinal mass at thoracic (T2-9) region. CT guided biopsy was done and HPE results showed inflammation with actinomyces infection. Treatment with Intravenous (IV) Crystalline penicillin 4 mega unit q.i.d. was started and planned to continue for 4 weeks, followed by oral Penicillin 6-12 months. After 1 week of IV antibiotics, white cell count and C Reactive Protein level reduced to 50% of pre-treatment levels. Unfortunately, there was no improvement in neurology. Decompression and spinal fixation was offered but patient refused and opted for conservative management. Conclusion: This case report highlights the rare presentation of cord compression due to actinomycosis of thoracic spine, wherein the importance of biopsy obviously precedes clinical and radiological diagnosis.

AB - Objective: To highlight the rare presentation of spinal cord compression due to actinomycosis. Materials and methods: We report a case of spinal cord compression caused by Actinomyces israelii in a 42 year-old Malay gentleman, who presented with gradual onset of bilateral lower limb weakness and difficulty in passing urine for 3 months. He had no history of trauma to the spine or other medical illness. However, he had history of chronic cough for more than 6 weeks and weight loss of about 15 kg within 3 months. On physical examination, his neurological level was T12 ASIA Impairment Scale B. Laboratory tests indicated leukocytosis and raised C Reactive Protein level. Results: Computed Tomography Scan of the thorax and abdomen showed paraspinal mass at thoracic (T2-9) region. CT guided biopsy was done and HPE results showed inflammation with actinomyces infection. Treatment with Intravenous (IV) Crystalline penicillin 4 mega unit q.i.d. was started and planned to continue for 4 weeks, followed by oral Penicillin 6-12 months. After 1 week of IV antibiotics, white cell count and C Reactive Protein level reduced to 50% of pre-treatment levels. Unfortunately, there was no improvement in neurology. Decompression and spinal fixation was offered but patient refused and opted for conservative management. Conclusion: This case report highlights the rare presentation of cord compression due to actinomycosis of thoracic spine, wherein the importance of biopsy obviously precedes clinical and radiological diagnosis.

KW - Actinomycosis

KW - Paraplegia

KW - Spinal cord compression

KW - Spinal infection

UR - http://www.scopus.com/inward/record.url?scp=84870262569&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84870262569&partnerID=8YFLogxK

M3 - Article

VL - 19

SP - 356

EP - 358

JO - International Medical Journal

JF - International Medical Journal

SN - 1341-2051

IS - 4

ER -