Disclosures: Janice Z. Lau, DO: Nothing to disclose

Case Description:  The patient presented to the emergency department, following acupuncture, with low back pain, fever, and altered mental status. Lumbar puncture revealed Klebsiella meningitis and he was treated with ceftriaxone. He continued to spike fevers and was found with a disseminated Klebsiella infection including cervical, thoracic, and lumbar epidural abscesses, pneumonia, endophthalmitis, choroiditis, and buttock abscess.

Setting: Acute rehabilitation unit

Patient: A 50-year-old male with lumbar spondylosis.

Assessment/Results: Imaging revealed multiple epidural abscesses from C2-3 and T12-S1 and a T2 hyperintense cord compression. He underwent emergent C2 and partial upper C3 laminectomy. He was treated with cefepime and metronidazole for 8 weeks and transferred to the acute rehabilitation unit.

Discussion: Acupuncture is a form of traditional Chinese medicine that has been growing in popularity in Western Medicine. This case highlights that a spinal epidural abscess can occur as a rare, but potentially life-threatening complication of acupuncture. Spinal epidural abscesses occur in 0.2-2.8 cases per 10,000 per year. It continues to escalate due to increasing population in diabetes and spinal instrumentation. Diagnosis is challenging due to its nonspecific clinical presentation and may only present with fever. The classic triad includes fever, back pain, and neurologic deficits. Most common risk factors include diabetes, alcoholism, intravenous drug use, spinal intervention, and immunocompromised states, but up to 20% of patients have no predisposing factors. Our patient likely developed multiple abscesses by direct inoculation from the acupuncture needle into epidural space, and then developed disseminated bacteremia through hematogenous seeding. The most commonly isolated organism is Staphylococcus aureus (63%), followed by Klebsiella (16%). Diagnosis involves gadolinium-enhanced MRI. Treatment involves 4-6 weeks of antibiotics, surgical decompression, or drainage.

Conclusion: Physicians should be aware that spinal epidural abscesses can have a nonspecific presentation and can occur after acupuncture.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/multiple-spinal-epidural-abscesses-with-klebsiella-bacteremia-following-acupuncture-a-case-report/