This report describes a case of spinal epidural empyema with secondary infectious meningomyelitis in a two year old male castrated Mastiff. The patient presented to the CUHA Emergency Service for an acute, progressive, painful, non-ambulatory paraparesis after being lifted into the owner’s truck. Physical exam revealed an elevated temperature of 104.5*F and a T3-L3 myelopathy with severe thoracolumbar pain. Magnetic resonance imaging of the thoracolumbar spinal cord revealed an extensive, space occupying epidural lesion extending from approximately T8 to the level of the sacrum with concurrent intramedullary T2 hyperintesnity. Severe, locally extensive epaxial myositis was also present. Cerebrospinal fluid analysis (cerebellomedullary cistern) revealed hemorrhagic, opaque, suppurative fluid, with primarily non-degenerate neutrophils. A presumptive diagnosis of spinal epidural empyema with concurrent infectious meningomyelitis was made. Blood work revealed a stress leukogram and a non-regenerative anemia. Urinalysis was normal.
Given the severity and extensiveness of the lesion, surgical intervention was not pursued. Treatment included intravenous antibiotics (ampicillin/sulbactam, enrofloxacin, and clindamycin) for a presumptive infection, as well as fentanyl, dexmedetomidine, and lidocaine for pain. The patient was euthanized 2 days later due to deterioration of his neurologic status including loss of deep pain sensation despite treatment. Cultures of the CSF, blood, and urine were all positive for Streptococcus canis. Diagnosis and treatment of spinal epidural empyema and infectious meningomyelitis is discussed.