Abhishek Shrinet, MD
Resident Physician
Temple University Hospital
Philadelphia, Pennsylvania, United States
Arpun Shah, DO
Resident Physician
Ocean University Medical Center
Colonia, New Jersey, United States
Sudeep Peddireddy, M.D.
Resident Resident
Temple University Hospital
Emmaus, Pennsylvania, United States
Eric Xu, DO
Resident
Temple University
Philadelphia, Pennsylvania, United States
An 84-year-old immunocompetent female with a history of hypertension, diabetes mellitus, and coronary artery disease presented with intermittent fevers, dysphagia, abdominal pain, diffuse back pain, and ambulatory dysfunction, beginning 8 days after a dental procedure. Initial workup revealed Salmonella serogroup C1 bacteremia, and abdominal-pelvic computed tomography (CT) demonstrated gastritis. Subsequent X-ray and magnetic resonance imaging (MRI) of the lumbar spine appeared unremarkable. Progressive bilateral upper extremity weakness prompted cervical spine MRI, which identified a ventral epidural abscess extending from C5-T1, resulting in severe spinal canal stenosis and osteomyelitis/discitis at C6-C7 with spinal cord impingement. Infectious disease consultation linked the epidural abscess to hematogenous spread from Salmonella gastritis, likely exacerbated by her comorbidities and recent dental procedure. Neurosurgical evaluation recommended conservative management, and she was discharged to subacute rehabilitation and successively treated with 8 weeks of intravenous ceftriaxone.
Discussions: Non-typhoidal Salmonellae is a common cause of self-limited gastroenteritis, with invasive complications being rare in immunocompetent individuals. Epidural abscesses due to Salmonella are exceedingly unusual, with documented serovars mainly including S. Enteritidis, paratyphi A, Altona, and Agbeni. The role of serogroup C1 in invasive disease is poorly understood. While certain serovars exhibit multidrug resistance, the serogroup C1 abscess in this case responded to ceftriaxone monotherapy, without aspiration or surgical intervention, allowing functional gains through rehabilitation.
Conclusions: This rare case highlights successful treatment and recovery of a patient with spinal cord compression from Salmonella serogroup C1 gastritis-induced epidural abscess without surgical intervention in a subacute rehabilitation setting. Enhanced surveillance of Salmonella serovars may aid in conservative management by optimizing antibiotic selection for invasive salmonellosis complications.
