Acute adult cervical pyogenic discitis with neurological deterioration treated by antibiotics

Acute adult primary cervical pyogenic spondylodiscitis and discitis are usually treated with surgery and antibiotics, particularly for cases demonstrating neurological deficit. Here we report a case of acute adult primary cervical pyogenic discitis with the formation of epidural abscess treated with antibiotics alone. A 36-year-old male presented with neck and bilateral upper limb pain for 6 days. Physical examination showed evident nuchal rigidity and tenderness in the neck, and slight bilateral upper limb weakness. Laboratory findings revealed elevated white blood cell count, erythrocyte sedimentation rate and C-reactive protein level. Magnetic resonance imaging revealed epidural abscess extending from C4 to C6, resulting in anterior compression of the spinal cord. Blood culture detected Staphylococcus aureus. Although the disease had progressed and upper limb weakness was aggravated, only antibiotics without surgery were administered. The patient’s pain eased and body temperature, WBC count, ESR, and CRP normalized after antibiotics were administered intravenously. He was discharged after 3 weeks of antibiotic therapy. A follow-up MRI showed that the abscess had been absorbed completely, and no recurrence of discitis was found. In conclusion, cervical pyogenic discitis is a rare spinal infection and antibiotics can be effective in treating this disease, even if compression caused by epidural abscess leads to a neurological deficit.