(Kiosk 1) Prolonged Norovirus Infection in a Woman with an Epidural Abscess: A Case Report

Case Diagnosis: A 60-year-old woman with an epidural spinal abscess with a prolonged case of norovirus.

Case Description or Program Description: This patient presented to acute inpatient rehabilitation (AIR) after sustaining a nontraumatic spinal cord injury (NTSCI), secondary to epidural spinal abscess from staphylococcal endocarditis, which was treated with vancomycin. This patient’s pre-rehabilitation course was complicated by severe constipation, which was treated with two decompressive colonoscopies, a rectal tube and neostigmine and CT imaging was notable for colitis. She presented to AIR with ongoing constipation, and was initiated on a bowel program. Within three days of her admission, she developed left lower quadrant pain and tenderness as well as abdominal distention, which was initially concerning for ileus and subsequently developed loose stools. A comprehensive stool panel by polymerase chain reaction (PCR) was positive for norovirus. Due to worsening symptoms, she was transferred to an acute care hospital where she had an episode of vomiting in the emergency department. She was treated with osmotic laxatives and transferred back to AIR, where she continued to have symptoms of loose bowel movements, and had a subsequently positive repeat norovirus result by PCR.

Setting: Acute inpatient rehabilitation hospital.

Assessment/Results: 14 days after initially testing positive for norovirus, this patient was retested due to ongoing symptoms and tested positive for norovirus. She had symptoms of loose bowel movements with a single incidence of vomiting and was symptomatic for a total of 24 days since initially testing positive for norovirus.

Discussion (relevance): This is the first case reported, from our literature review, of a prolonged norovirus infection in a patient with a NTSCI. This case also highlights the atypical presentation of Norovirus in a patient with neurogenic bowel.

Conclusions: Patients with a NTSCI may be at risk for a prolonged norovirus infection.