Spondylodiscitis in a Patient with HIV Presenting with Sudden-Onset Tetraplegia
Abdalrhman Albuidair 1, Ajikumar Kavidasan *1, Rachel Kumar 1, Carmella Beastall 1, Elystan Cheetham 1
Correspondence to: Dr Ajikumar Kavidasan, Croydon University Hospital.
Copyright
© 2026 Dr Ajikumar Kavidasan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 17 July 2026
Published: 01 August 2026
Background
Spondylodiscitis is an uncommon but potentially life-threatening spinal infection, frequently caused by hematogenous spread of bacteria. Staphylococcus aureus remains the most common pathogen (1). Early recognition is essential, as delayed diagnosis can result in irreversible neurological deficit. Patients living with HIV, particularly those who are non-compliant with antiretroviral therapy, are at increased risk of severe or atypical infectious presentations due to underlying immunosuppression.
Here, we present a case of rapidly progressive tetraplegia secondary to spondylodiscitis and spinal epidural abscess in a patient with poorly controlled HIV.
Case Report
A 43-year-old man presented following a sudden collapse while walking, associated with an inability to move his limbs. His symptoms partially improved shortly after the episode, allowing him to attend the emergency department unaided. Whilst in hospital, however, he developed progressive numbness affecting all four limbs.; Powers on the Medical Research Council (MRC) were 2/5 globally.
His past medical history included HIV infection, diagnosed four years previously. He further had a history of intravenous drug use of mostly crystal myth. He was not on ART.
On initial assessment he was alert, haemodynamically stable and afebrile. Laboratory investigations showed raised inflammatory markers, and blood cultures grew Staphylococcus aureus. Given his worsening neurological signs, spinal infection with potential epidural abscess was strongly suspected.
The patient deteriorated rapidly, and due to concerns about airway protection and the need for urgent neurosurgical intervention, he was intubated and transferred to a tertiary neurosurgical centre. MRI demonstrated extensive spondylodiscitis with associated epidural abscess causing significant spinal cord compression.
He underwent emergency surgical decompression and drainage. Post-operatively, he underwent neuro-rehabilitation with significant improvement in lower-limb power, although residual upper-limb weakness persisted. Measured powers on the MRC scale were 5/5 on the right upper limb myotomes, and 3/5 on left wrist extension and flexion. Right lower limb powers were 4/5 and on the left were 3/5. He was treated with intravenous flucloxacillin 2 g four times daily, guided by microbiology advice. Following exclusion of infective endocarditis on echocardiography and clinical improvement after source control, he was stepped down to oral doxycycline to complete a six-week antibiotic course.
The patient was counselled regarding the importance of adherence to HIV therapy. The HIV viral load of 679,000 copies/ml and CD4 count of 104 cells/mm^3.
Discussion
This case demonstrates a rapidly progressive spinal infection resulting in tetraplegia in a patient with untreated HIV. Immunosuppression increases susceptibility to invasive bacterial infections, and S. aureus bacteraemia is a well-recognised precipitant of spondylodiscitis(2).
Early clinical findings may be non-specific, and neurological deterioration can evolve insidiously or precipitously. In this case, the patient initially regained some mobility following his collapse, potentially masking the severity of underlying pathology. The subsequent rapid neurological deterioration highlights the importance of maintaining a high index of suspicion in at-risk patients.
Neurological compromise in the context of suspected spinal infection constitutes a neurosurgical emergency. Prompt imaging—ideally MRI—and early decompression are critical in preventing permanent disability(3)(4). The initial CT scan in this case did not demonstrate the infection, and transfer to the nearest neurosurgical centre was decided purely based on clinical suspicion of a cervical lesion. A MRI scan conducted later on, revealed the presence of the infection as can be seen in figure 1. This patient’s favourable neurological recovery following surgery emphasises the importance of early intervention.
Poor adherence to antiretroviral therapy likely contributed to his vulnerability to systemic infection and severe complications. This case therefore underscores not only the diagnostic and management challenges in spinal infections but also the broader importance of optimising HIV care to reduce infectious morbidity(5).
Conclusion
Spondylodiscitis should be considered in patients with HIV presenting with new neurological deficits, especially in the presence of S. aureus bacteraemia. Early recognition and urgent neurosurgical management are essential to prevent permanent neurological damage. Improved adherence to antiretroviral therapy remains vital in reducing the risk of severe infections in this patient population.
References