Two cases of Pseudomonas aeruginosa epidural abscesses and cervical osteomyelitis after dental extractions.

STUDY DESIGN: Case report. OBJECTIVES: To report 2 unusual cases of Pseudomonas aeruginosa epidural abscesses and cervical osteomyelitis after routine dental extractions and to review relevant literature. SUMMARY OF BACKGROUND DATA: Pseudomonas aeruginosa is a rare cause of cervical osteomyelitis in patients after dental extractions. Only 1 prior case could be found in the literature. METHODS: The cases of an 18-year-old male and a 23-year-old female are presented. PubMed was used to search for relevant literature. RESULTS: Our 2 patients presented with excruciating neck pain within 24 hours of routine dental extractions and, by imaging were found to have cervical epidural abscesses and osteomyelitis. Both patients were taken to the operating room for drainage and corpectomy and treated with prolonged courses of intravenous antibiotics. When seen in follow up 3 months later, neither patient demonstrated any neurologic sequelae. CONCLUSION: Pseudomonas aeruginosa epidural abscesses and osteomyelitis of the cervical spine have only rarely been reported in healthy patients after dental extractions. To our knowledge, the 2 patients reported here are only the second 2 such cases reported in the literature. Unfortunately, as in prior cases, these 2 patients had a significant delay in diagnosis. Therefore, a strong suspicion must be maintained for all patients presenting with neck pain after a recent dental extraction and appropriate imaging must be obtained urgently.