Acinetobacter baumanii De Novo Soft Tissue Infection Causing Higher Cervical Spinal Cord Compression - A Case Report

Abstract

INTRODUCTION: Acinetobacter baumannii is generally considered an opportunistic nosocomial pathogen and is rarely encountered as a pathogen causing community-acquired soft tissue infection. CASE PRESENTATION: A 54 year old female presented with bilateral hand pain followed by all four extremity weakness and urinary incontinence over a period of two months. She has h/o well controlled hypertension, diabetes mellitus type 2 and arthritis. No h/o previous surgery. She denied smoking, alcohol drinking and illicit drug use. Here vitals were stable and neuro examination showed loss of touch sensations on right side of the face and body, right flaccid hemiplegia and left spastic hemiplegia. There was lymphadenopathy. Her routine blood workup was with in normal limits with negative HIV testing. PPD was positive, AFB sputum smear time three came back negative and chest Xray was negative. There was an extradural circumferential mass causing compression at the level of C1, C2 and C3 on contrast enhanced MRI of the cervical spinal cord. CT guided core biopsy of the mass was done. Gram staining showed rare WBC and gram negative rods, AFB smear was negative while culture grew abundant gram negative rods- Acinetobacter baumanii. After treatment with antibiotics clinically patient improved. DISCUSSION: Acinetobacter baumannii is an aerobic gram-negative coccobacillary rod with a natural reservoir in soil and water sources around the world. It is generally considered an opportunistic nosocomial pathogen , affecting especially patients receiving treatment in the intensive care unit setting and immunocompromised patients. This is the first reported case of community-acquired A. baumannii denovo soft tissue infection causing higher cervical spinal cord compression resulting in quadriplegia. The evidence is now mounting that A. baumannii can no longer be exclusively considered a nosocomial pathogen, and is capable of causing profound clinical disease in the absence of traditional nosocomial risk factors. CONCLUSIONS: We described a patient who is from community, non smoker, and non alcoholic, had well controlled DM -2 and had no h/o trauma/surgery. The case raises concerns that this highly adaptable organism may soon evolve into a significant community pathogen, too.