Actinomycosis as a Very Rare Cause of Thoracic Spinal Cord Compression: Clinical Note

Objective: To highlight the rare presentation of spinal cord compression due to actinomycosis. Materials and methods: We report a case of spinal cord compression caused by Actinomyces israelii in a 42 year-old Malay gentleman, who presented with gradual onset of bilateral lower limb weakness and difficulty in passing urine for 3 months. He had no history of trauma to the spine or other medical illness. However, he had history of chronic cough for more than 6 weeks and weight loss of about 15 kg within 3 months. On physical examination, his neurological level was 112 ASIA Impairment Scale B. Laboratory tests indicated leukocytosis and raised C Reactive Protein level. Results: Computed Tomography Scan of the thorax and abdomen showed paraspinal mass at thoracic (T2-9) region. CT guided biopsy was done and HPE results showed inflammation with actinomyces infection. Treatment with Intravenous (IV) Crystalline penicillin 4 mega unit q.i.d. was started and planned to continue for 4 weeks, followed by oral Penicillin 6-12 months. After 1 week of IV antibiotics, white cell count and C Reactive Protein level reduced to 50% of pre-treatment levels. Unfortunately, there was no improvement in neurology. Decompression and spinal fixation was offered but patient refused and opted for conservative management. Conclusion: This case report highlights the rare presentation of cord compression due to actinomycosis of thoracic spine, wherein the importance of biopsy obviously precedes clinical and radiological diagnosis.