Spinal Epidural Abscess in COVID-19 patients

Abstract Objective: To report the peculiarities of spinal epidural abscess in COVID-19 patients, because we observed an unusually high number of these patients following the outbreak of SARS-Corona Virus-2.Methods: We reviewed the clinical documentation of six consecutive COVID-19 patients with primary spinal epidural abscess that we had to surgically manage during a two-month period. These cases were analyzed for what concerns both the viral infection and the spinal abscess.Results: Abscess was primary in all cases meaning that no evident infective source was found. Primary abscess represents the rarest form of spinal epidural abscess, which is usually secondary to invasive procedures or spreading from adjacent infective sites, such as spondylodiscitis and generally occurs in patients with diabetes, obesity, cancer, or other chronic disease. In all cases, there was mild lymphopenia but the spinal abscess occurred regardless the severity of the viral disease, the immunologic state, and the presence of bacteremia. Obesity was the only risk factor and was reported just in two patients. All patients but one were hypertensive. The preferred localizations were cervical and thoracic, whereas the classic abscess generally occurs at lumbar level. No patient had history of pyogenic infection, even though previous asymptomatic bacterial contaminations were reported in three cases.Conclusion: We wonder about the concentration of this uncommon disease in a so short period. To our knowledge, cases of epidural spinal abscess in COVID-19 patients have been not yet reported. Accordingly, we ignore if the SARS-Corona Virus-2 may really predispose to spinal epidural abscesses. However, we hypothesize that, in our patients, the spinal infection could have depended on the coexistence of an initially asymptomatic bacterial contamination. The well-known COVID-19-related endotheliitis might have created the conditions for retrograde bacterial invasion of the correspondent spinal epidural space. Anyway, the spinal epidural abscess carries significantly high morbidity and mortality. It is difficult to diagnose, especially in compromised COVID-19 patients but it should be kept in mind because early diagnosis and treatment are crucial.