Infection caused by Aeromonas sobria, complicated by lower extremity paraplegia and the cauda equine syndrome in a patient with well-controlled type 2 diabetes

Aeromonas species are Gram-negative anaerobes with the natural habitat of fresh and seawater watercourses and have also been found in stagnant and flowing water reservoirs, water tanks as well as moist soil [1]. The literature primarily describes cases of alimentary tract infections [2] and occasionally sepsis or inflammation of the fascia and muscles [3]. A 75-year-old woman was admitted to the Neurology Department of the University Hospital in Bydgoszcz because of lower extremity muscle weakness developing for 2 weeks and was accompanied by bilateral foot drop and lumbosacral pain irradiating along the posterior surface of both thighs. Approximately 7 days before admission urinary and faecal incontinence as well as an increase of body temperature up to 38.5°C were observed. Type 2 diabetes was diagnosed a year ago, treated with a diet, and with a well-controlled glycaemia. The patient has a negative family history of neoplastic and haematological diseases without addictions. A neurological examination at admission revealed that the patient suffered from cauda equine syndrome accompanied by lower extremity flaccid paresis and multiple neuritis syndrome accompanied by reduced sensation of gloves-socks type. Aberrations discovered during additional examinations were as follows: C-reactive protein (CRP) 56 mg/l, white blood cells (WBC) 12.25 × 10/μl, hyperglycaemia 19.8 mmol/l, hypoalbuminaemia 19.2 g/l. A general urine analysis revealed presence of acetone, protein, glucose and microscopic haematuria. Whereas the concentration of total bilirubin in the blood serum was increased to 124 μmol/l, aspartate transaminase, alanine transaminase and alkaline phosphatase were normal, γ-glutamyl transpeptidase level was slightly increased (97 U/l). Spine magnetic resonance imaging with contrast showed as follows: presence of fluid collections resembling abscesses on various levels of the vertebral canal, in the right iliopsoas muscle, where the suspicion of abscesses was additionally intensified by the presence of gas bubbles. Gas bubbles were also visible in the left iliopsoas muscle, vertebral canal as well as L4 and L5 vertebral bodies. A small amount of pathological tissue not enhanced by contrast was visible instead of fat in the sacral canal, on the S1 level with sacral bone defects in front of it. Empirical antibiotic therapy was introduced through intravenous administration of amoxicillin with clavulanic acid (2 × 1.2 g). Gradual normaliCorresponding author: Małgorzata Szafrańska MD Department of Endocrinology and Diabetology Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum 9 Skłodowskiej-Curie St 85-094 Bydgoszcz, Poland Phone: +48 52 585 40 20 Fax: +48 52 585 40 41 E-mail: [email protected] Letter to the Editor