Pneumorrhachis of Infectious Origin in a Patient with Advanced HIV and Uncontrolled Diabetes: A Case Report and Review of the Literature

Pneumorrhachis, the presence of air within the spinal canal, is an uncommon radiological finding, typically associated with trauma or pneumomediastinum. Non-traumatic causes, particularly infective ones, are exceedingly rare. We describe a woman with advanced HIV infection and poorly controlled diabetes mellitus who presented with confusion and meningism in the context of diabetic ketoacidosis (DKA). Computed tomography (CT) revealed cervical extradural pneumorrhachis. Blood, urine, sputum, and cerebrospinal fluid (CSF) cultures confirmed disseminated methicillin-resistant Staphylococcus aureus (MRSA) infection. This case adds to the limited literature describing pneumorrhachis of infectious origin unrelated to trauma or pneumomediastinum. A review of published cases shows that most are associated with emphysematous infections (epidural abscesses, pyelonephritis, cystitis, or meningitis) caused by gas-forming organisms. While pneumorrhachis itself is often incidental and self-limiting, it is an indicator of severe underlying disease. However, due to the limited number of reported cases, morbidity and mortality are yet to be defined. Recognition of pneumorrhachis should prompt urgent investigation for an infective source and initiation of appropriate antimicrobial therapy.