Salmonella Epidural Abscess in a Patient With Rheumatoid Arthritis Treated With Tocilizumab

Abstract

A 59-year-old woman with a 23-year history of rheumatoid arthritis and treated with tocilizumab for the previous 6 months was referred to the neurosurgery service with neck pain and upper extremity paresthesias. Magnetic resonance imaging of the cervical spine showed an epidural abscess with associated vertebral osteomyelitis. Culture of a computed tomography–guided aspirate from the abscess grew Salmonella enteridis as did cultures from a subsequent surgical debridement with C4-5 vertebrectomies and C3-6 fusion. The patient subsequently recalled a diarrheal illness associated with consumption of tomatoes purchased from a farmers' market approximately 3 weeks before the onset of her symptoms. We postulate that, during that illness, she had transient Salmonella bacteremia with seeding of the cervical epidural space.