Anterior cord syndrome is a rare yet critical neurological condition that poses significant challenges in clinical management. We present the case of a 71-year-old male with a medical history of hypertension, uncontrolled type II diabetes mellitus, hypothyroidism, and end-stage renal disease requiring dialysis who presented to the emergency department with complaints of chills, back pain, abdominal pain, and vomiting episodes. Based on the severity of the patient's illness, it was decided that inpatient admission would be best. At the beginning of the patient's hospital stay, blood cultures grew methicillin-resistant Staphylococcus aureus. In addition, the results of the MRI revealed progressive vertebral body osteomyelitis and discitis at the T10-T11 level, along with surrounding inflammation and edema. During the patient's hospital stay, the patient's neurological condition worsened, and he presented with the onset of bilateral lower limb flaccid paralysis, numbness, and weakness. An MRI of the thoracic spine with and without contrast revealed worsening osteomyelitis and discitis at T10-T11. Given these findings, neurology and orthopedic surgery were consulted. The neurology team diagnosed the patient with anterior cord syndrome. The orthopedic surgery team recommended decompression and a posterior laminectomy. Due to the patient's pre-existing pulmonary issues, uncontrolled type II diabetes mellitus, and chronic kidney disease, the orthopedic surgery team decided to proceed with a posterior decompression through the transpedicular route. Given the presence of bacteremia, a Hickman catheter was placed in the right subclavian vein for continued IV antibiotic treatment. On the last day of hospitalization, the patient was discharged to a long-term acute care facility for continued treatment. Collaboration amongst hospitalists, infectious disease specialists, neurosurgeons, and rehabilitation teams is required in order to facilitate early recognition of critical clinical symptoms in managing complex MRSA-induced spinal cord infections. The complexity of this case is due to the patient's comorbid conditions. Correlating the symptoms of constipation and bladder dysfunction to a neurogenic cause was a challenge for this patient in the setting of hypothyroidism and opioid usage. In summary, early detection of infection and promptly working with physical therapy are critical in order to prevent catastrophic neurological consequences in patients with multiple comorbidities.
Keywords: anterior cord syndrome; end stage renal disease (esrd); methicillin-resistant staphylococcus aureus; mri imaging; vertebral osteomyelitis.
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