title: Epidural abscess caused by Streptococcus milleri in a pregnant woman.
abstract: BACKGROUND
  Bacteria in the Streptococcus milleri group (S. anginosus, S. constellatus, and S. intermedius) are associated with bacteremia and abscess formation. While most reports of Streptococcus milleri group (SMG) infection occur in patients with underlying medical conditions, SMG infections during pregnancy have been documented. However, SMG infections in pregnant women are associated with either neonatal or maternal puerperal sepsis. Albeit rare, S. milleri spinal-epidural abscess in pregnancy has been reported, always as a complication of spinal-epidural anesthesia. We report a case of spinal-epidural abscess caused by SMG in a young, pregnant woman without an antecedent history of spinal epidural anesthesia and without any underlying risk factors for invasive streptococcal disease.
  
  
  METHODS
  A 25 year old pregnant woman developed neurological symptoms consistent with spinal cord compression at 20 weeks gestation. She underwent emergency laminectomy for decompression and was treated with ceftriaxone 2 gm IV daily for 28 days. She was ambulatory at the time of discharge from the inpatient rehabilitation unit with residual lower extremity weakness.
  
  
  CONCLUSIONS
  To our knowledge, this is the first reported case of a Streptococcus milleri epidural abscess in a healthy, pregnant woman with no history of epidural anesthesia or invasive procedures. This report adds to the body of literature on SMG invasive infections. Treatment of SMG spinal-epidural abscess with neurologic manifestations should include prompt and aggressive surgical decompression coupled with targeted anti-infective therapy.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA. lampenru@hotmail.com
authors.forename: Russell
authors.initials: R
authors.lastname: Lampen
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Bearman
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D020802:Epidural Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D005260:Female; D006801:Humans; D011247:Pregnancy; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D034364:Streptococcus milleri Group / Q000302:isolation & purification / Q000502:physiology*
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone