Successful Conservative Management of Delayed Cervical Spondylodiscitis with Epidural Abscess Caused by Esophageal Diverticulitis: A Case Report and Review of Literature

BACKGROUND: Cervical spondylodiscitis with spinal epidural abscess (SEA) is not a rare medical condition and usually requires urgent decompression of neural structures and stabilization of the spine followed by antibiotic therapy for the prevention of severe neurologic deficits. CASE DESCRIPTION: In this report, we present a 43-year-old male patient with the chief complaint of neck pain and intermittent fever accompanying by slight dysphagia. After 2 weeks, he felt mild and transient numbness on the left upper limb. He had a history of esophageal intervention under endoscopy. Magnetic resonance imaging disclosed diffuse hyperintensity in the left paraesophageal and prevertebral tissues and a space-occupying lesion within the spinal canal. The esophagography revealed a saclike barium collection parallel to the upper esophagus herniating out from the posterior wall without evident leakage. Neither surgical decompression nor drainage was chosen by this patient; conservative treatment with antibiotic administration was managed to achieve a good neurologic recovery and remarkable resolution of the epidural abscess. During antibiotic therapy and dietary restriction, the symptoms of diverticulitis was also managed expectantly. CONCLUSIONS: Physicians need to be aware of this rare case of SEA secondary to esophageal diverticulitis. An early diagnosis and prompt administration of antibiotics is a key factor to avoid neurologic deterioration for the treatment of SEA caused by diverticulitis. Endoscopic or surgical repair of diverticulum may be warranted to avoid the recurrence of such infection.