Intramedullary Spinal Cord Abscess Caused by Acupuncture

A 27-year-old man was admitted to our hospital for a 1-week history of acute bilateral upper limbs weakness, pain, and numbness. Those symptoms progressively aggravated in a short period, and were accompanied with urinary retention and constipation. Physical examination showed decreased sensation in the prechest and abdomen, and the meningeal irritation sign was negative. Medical history revealed he received acupuncture for his cervical pain in local clinic. Cervicothoracic spinal magnetic resonance imaging revealed an intramedullary lesion located in the C3 to T3 segment with heterogeneous enhancement, multiple syringomyelia formation, and diffused spinal edema, which indicated an intramedullary spinal cord abscess (Fig 1A–C). A systemic screen showed no evidence of infection in other organs, and routine screening laboratories including white blood cells, procalcitonin, inflammatory markers, coagulation indicator, and tumor markers were normal, and blood cultures were negative. A lumbar puncture showed low pressure and slow flow of cerebrospinal fluid, which revealed spinal obstruction. Cerebrospinal fluid examination showed 173 mononuclear cells/μl, 0.83 g/L protein, and normal glucose and lactate levels. This patient's cerebrospinal fluid bacterial cultures were all negative. Therefore, cervicothoracic intramedullary spinal cord abscess was considered, and surgical decompression of the spinal cord and drainage of the intramedullary abscess were performed. The bacterial culture of pyogenic fluid revealed Klebsiella pneumoniae with a hyperviscous phenotype (Fig 2). Moreover, the whole-genome sequencing and additional polymerase chain reaction testing identified the results of hypervirulent Klebsiella pneumoniae. The patient received ceftazidime/avibactam and aztreonam. However, the patient's condition progressively worsened with quadriparesis, and he eventually died of subsequent respiratory failure. Physicians should be aware that intramedullary spinal cord abscess is a potential life-threatening complication of acupuncture that is commonly attributed to contaminated needles. Hypervirulent Klebsiella pneumoniae is a highly invasive, highly pathogenic pathogen, characterized by its hypermucoviscous phenotype.1 It can cause liver abscesses, meningitis, and other site infections, which usually progress rapidly and have a poor prognosis.2, 3 Intramedullary spinal cord abscess is rare manifestations of hypervirulent Klebsiella pneumoniae infection. J.L. and S.Z. contributed to study concept and design. J.L. and H.G. contributed to data acquisition and analysis. J.L., S.Z., and H.G. contributed to drafting the manuscript and preparing figures. Nothing to report. The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.