{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T17:15:15Z","timestamp":1783358115177,"version":"3.54.6"},"reference-count":24,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Background: Spinal epidural abscesses (SEA) are rare, occurring 2.5\u20133 times per 10,000 hospital admissions. While streptococcus species comprise 7% of reported SEAs, Group A Streptococcus (GAS) has been described only once in the medical literature to our knowledge. Case presentation: We present a case of GAS pharyngitis with subsequent paraplegia from a GAS SEA. A 33-year-old female presented to the emergency department (ED) and was initially diagnosed with GAS pharyngitis and a suspected strained lower back. Following treatment with amoxicillin, she returned with worsened back pain, radiculopathy, and leukocytosis, for which she was treated with cyclobenzaprine. On her third presentation, she had new bilateral lower extremity weakness with decreased sensation, bilateral ankle clonus, and hyperreflexia. MRI of the thoracic and lumbar spine revealed a multiloculated SEA at T5-T10 requiring laminectomy and abscess evacuation. Intraoperative cultures grew Streptococcus pyogenes. Despite surgery, medical management, and physical therapy, she remained paraplegic. Conclusions: To our knowledge, this is the first report of SEA preceded by GAS pharyngitis. This case exposes the critical association between a recent infection, progression of back pain, eventual neurologic symptoms, and inflammatory markers that should trigger concern for SEA and early evaluation with MRI.<\/jats:p>","DOI":"10.3390\/idr18040068","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T14:01:08Z","timestamp":1783346468000},"page":"68","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Case of Spinal Epidural Abscess and Paraplegia After Group A Streptococcal Pharyngitis"],"prefix":"10.3390","volume":"18","author":[{"given":"Blake J.","family":"McKinley","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob M.","family":"Seby","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Chase","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4531-277X","authenticated-orcid":false,"given":"Tatjana","family":"Gavrancic","sequence":"additional","affiliation":[{"name":"Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Collado","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6964-5956","authenticated-orcid":false,"given":"Libardo","family":"Rueda Prada","sequence":"additional","affiliation":[{"name":"Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.2147\/IDR.S405448","article-title":"Acute Spinal Epidural Abscess of the Cervical Spine Caused by Streptococcus constellatus Leads to Paraplegia in an Adult: A Case Report","volume":"18","author":"Zhang","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e250733","DOI":"10.1136\/bcr-2022-250733","article-title":"Streptococcus gallolyticus-related spinal epidural abscess","volume":"15","author":"Agrawal","year":"2022","journal-title":"BMJ Case Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/qjmed\/hcm100","article-title":"Spinal epidural abscess in clinical practice","volume":"101","author":"Sendi","year":"2008","journal-title":"QJM Int. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1056\/NEJMra1516539","article-title":"Acute Spinal Cord Compression","volume":"376","author":"Ropper","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_5","first-page":"S26","article-title":"Spinal Epidural Abscess","volume":"5","author":"Luo","year":"2020","journal-title":"J. Educ. Teach. Emerg. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2014.6.FOCUS14127","article-title":"Medical and surgical management of spinal epidural abscess: A systematic review","volume":"37","author":"Arko","year":"2014","journal-title":"Neurosurg. Focus"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Liu, D., Lu, W., Huang, W., Zhai, W., and Ling, Q. (2023). Extensive spinal epidural abscess due to Streptococcus intermedius: A case report treated conservatively and literature review. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1237007"},{"key":"ref_8","first-page":"127","article-title":"Spontaneous Pan-Vertebral Epidural Abscesses Caused by Streptococcus intermedius in an Immunocompetent Patient","volume":"17","author":"Emmanuel","year":"2020","journal-title":"Am. J. Infect. Dis. Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3325","DOI":"10.2147\/IDR.S257398","article-title":"Studies on 11 Cases of Spinal Epidural Abscess and Literature Review","volume":"13","author":"Dai","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"22","DOI":"10.14245\/kjs.2015.12.1.22","article-title":"Cervical epidural abscess: Rare complication of bacterial endocarditis with Streptococcus viridans: A case report","volume":"12","author":"Oh","year":"2015","journal-title":"Korean J. Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e01853","DOI":"10.1016\/j.idcr.2023.e01853","article-title":"Epidural abscess secondary to Streptococcus pneumoniae. A case report and review of the literature","volume":"33","author":"Leavitt","year":"2023","journal-title":"IDCases"},{"key":"ref_12","first-page":"100067","article-title":"Pediatric Group A streptococcal spinal epidural abscess presenting with recurrent symptoms of viral illness: An operative case report","volume":"6","author":"Vig","year":"2021","journal-title":"N. Am. Spine Soc. J."},{"key":"ref_13","unstructured":"Tintinalli, J.E., Ma, O.J., Yealy, D.M., Meckler, G.D., Stapczynski, J.S., and Cline, D.M. (2020). Central Nervous System and Spinal Infections. Tintinalli\u2019s Emergency Medicine: A Comprehensive Study Guide, McGraw-Hill Education. [9th ed.]. Available online: https:\/\/accessemergencymedicine.mhmedical.com\/content.aspx?bookid=2353&sectionid=220293696."},{"key":"ref_14","unstructured":"Ameer, M.A., Knorr, T.L., Munakomi, S., and Mesfin, F.B. (2024, May 06). Spinal Epidural Abscess, StatPearls [Internet], Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441890\/."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1056\/NEJMra055111","article-title":"Spinal epidural abscess","volume":"355","author":"Darouiche","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1007\/s00381-014-2479-3","article-title":"Spinal epidural abscess from group A Streptococcus after varicella infection: A case report and review of the literature","volume":"30","author":"Cossu","year":"2014","journal-title":"Childs Nerv. Syst."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e170","DOI":"10.1017\/ash.2023.449","article-title":"Antibiotic prescribing for adults with group A streptococcal bacteremia in a large healthcare system","volume":"3","author":"Gillins","year":"2023","journal-title":"Antimicrob. Steward. Healthc. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.ajem.2022.01.008","article-title":"High risk and low prevalence diseases: Spinal epidural abscess","volume":"53","author":"Long","year":"2022","journal-title":"Am. J. Emerg. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.jemermed.2003.11.013","article-title":"The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess","volume":"26","author":"Davis","year":"2004","journal-title":"J. Emerg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"395","DOI":"10.2214\/AJR.19.21674","article-title":"Use of Imaging During Emergency Department Visits for Low Back Pain","volume":"214","author":"Pakpoor","year":"2020","journal-title":"Am. J. Roentgenol."},{"key":"ref_21","unstructured":"(2024, May 06). ACEP Now. ACEP Announces New Choosing Wisely List. Available online: https:\/\/www.acepnow.com\/article\/acep-announces-new-choosing-wisely-list\/."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"765","DOI":"10.3171\/2011.1.SPINE1091","article-title":"Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain: Clinical article","volume":"14","author":"Davis","year":"2011","journal-title":"J. Neurosurg. Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"742","DOI":"10.31616\/asj.2019.0369","article-title":"Spinal Epidural Abscess: A Review of Presentation, Management, and Medicolegal Implications","volume":"14","author":"Sharfman","year":"2020","journal-title":"Asian Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1093\/bja\/ael006","article-title":"Epidural abscesses","volume":"96","author":"Grewal","year":"2006","journal-title":"BJA Br. J. Anaesth."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/18\/4\/68\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T16:23:18Z","timestamp":1783354998000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/18\/4\/68"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,4]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["idr18040068"],"URL":"https:\/\/doi.org\/10.3390\/idr18040068","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,4]]}}}