Objective

To report the peculiarity of spinal epidural abscess in COVID-19 patients, as we have observed an unusually high number of these patients following the outbreak of SARS-Corona Virus-2.

Methods

We reviewed the clinical documentation of six consecutive COVID-19 patients with primary spinal epidural abscess that we surgically managed over a 2-month period. These cases were analyzed for what concerns both the viral infection and the spinal abscess.

Results

The abscesses were primary in all cases indicating that no evident infective source was found. A primary abscess represents the rarest form of spinal epidural abscess, which is usually secondary to invasive procedures or spread from adjacent infective sites, such as spondylodiscitis, generally occurring in patients with diabetes, obesity, cancer, or other chronic diseases.

In all cases, there was mild lymphopenia but the spinal abscess occurred regardless of the severity of the viral disease, immunologic state, or presence of bacteremia. Obesity was the only risk factor and was reported in two patients. All patients but one were hypertensive. The preferred localizations were cervical and thoracic, whereas classic abscess generally occur at the lumbar level. No patient had a history of pyogenic infection, even though previous asymptomatic bacterial contaminations were reported in three cases.

Conclusion

We wonder about the concentration of this uncommon disease in such a short period. To our knowledge, cases of spinal epidural abscess in COVID-19 patients have not been reported to date. We hypothesize that, in our patients, the spinal infection could have depended on the coexistence of an initially asymptomatic bacterial contamination. The well-known COVID-19-related endotheliitis might have created the conditions for retrograde bacterial invasion to the correspondent spinal epidural space.

Furthermore, spinal epidural abscess carries a significantly high morbidity and mortality. It is difficult to diagnose, especially in compromised COVID-19 patients but should be kept in mind as early diagnosis and treatment are crucial.

中文翻译：

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COVID-19 患者的脊髓硬膜外脓肿。

客观的

报告 COVID-19 患者脊髓硬膜外脓肿的特殊性，因为我们观察到在 SARS-Corona Virus-2 爆发后这些患者的数量异常多。

方法

我们回顾了 2 个月内通过手术治疗的 6 例原发性脊髓硬膜外脓肿的连续 COVID-19 患者的临床文件。对这些病例的病毒感染和脊柱脓肿进行了分析。

结果

所有病例均为原发性脓肿，表明未发现明显感染源。原发性脓肿是脊柱硬膜外脓肿最罕见的形式，通常继发于侵入性手术或从邻近感染部位扩散，例如脊椎盘炎，通常发生在患有糖尿病、肥胖症、癌症或其他慢性疾病的患者身上。

在所有病例中，都有轻度淋巴细胞减少，但无论病毒疾病的严重程度、免疫状态或菌血症的存在如何，都会发生脊柱脓肿。肥胖是唯一的危险因素，并在两名患者中报告。除一名患者外，所有患者均患有高血压。优选的定位是颈椎和胸椎，而典型的脓肿通常发生在腰椎水平。没有患者有化脓性感染史，尽管在 3 例病例中报告了先前的无症状细菌污染。

结论

我们想知道这种罕见疾病在如此短的时间内的集中度。据我们所知，迄今为止尚未报告 COVID-19 患者的硬脊膜外脓肿病例。我们假设，在我们的患者中，脊柱感染可能取决于最初无症状的细菌污染的共存。众所周知的 COVID-19 相关内皮炎可能为细菌逆行侵入相应的脊髓硬膜外腔创造了条件。

此外，硬脊膜外脓肿的发病率和死亡率都很高。很难诊断，尤其是在 COVID-19 感染患者中，但应牢记，因为早期诊断和治疗至关重要。