Junhong He,1,2 Yang Wang,2,3 Qiong Yang1,2 

1Department of Pharmacy, Ningbo No.6 Hospital, Ningbo, Zhejiang, People’s Republic of China; 2Ningbo Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Ningbo, Zhejiang, People’s Republic of China; 3Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People’s Republic of China

Correspondence: Qiong Yang, Email yangqiong02164516@163.com

Abstract: Erythema multiforme, an inflammatory skin and mucosal condition, is mainly caused by a viral infection and presents as plaques of various morphologies. We present the case of a 59-year-old man who developed a pruritic rash all over his body seven days after posterior cervical single-open-door spinal decompression surgery. He had no history of a viral rash. He received antibiotics and anti-allergic treatment without relief of symptoms. Suspecting a viral infection, antivirals were started. While the rash subsided, the inflammatory markers continued to increase, accompanied by hyperpyrexia, leading to the suspicion of secondary bacterial infection. Meropenem was started, and the patient’s vital signs returned to normal. This is a rare case of erythema multiforme and secondary bacterial infection following cervical spine surgery. Based on our findings, antimicrobial therapy is recommended for patients with viral infection after cervical spine surgery in the following situations: bacterial infection was not confirmed by the blood cultures obtained, and was suspected by the patients’ course and elevated infection indices.

Keywords: cervical spine surgery, erythema multiforme, secondary bacterial infection, hyperpyrexia