Diabetes mellitus and spinal epidural abscess: clinical or surgical treatment?

Abstract

SUMMARYSpinal epidural abscess (SEA) is an uncommon condition and its most important predisposing factor is diabetes mellitus. Although the treatment of choice is prompt surgical abscess evacuation, followed by antibiotic therapy, successful conservative treatment of SEA has been reported in some cases. We describe a SEA case in a 23-year old white woman with diabetes for 14 years, who was successfully treated only with antibiotics, and achieved full recovery at the fourth month of follow-up. Arq Bras Endocrinol Metab. 2011;55(9):720-2 SUMÁRIO O abscesso epidural espinhal (AEE) é uma doença incomum e o diabetes melito é o seu fator predisponente mais importante. O tratamento de escolha é a imediata drenagem cirúrgica, seguida de antibioticoterapia, entretanto, casos já foram relatados em que o AEE foi tratado clinicamente com sucesso. Descrevemos um caso de AEE em um paciente diabético tratado satisfatoriamente com uso isolado de antibióticos e que evoluiu com recuperação total no quarto mês de seguimento. Arq Bras Endocrinol Metab. 2011;55(9):720-2

Insidious Onset of Tetraparesis due to Cervical Epidural Abscess fromEnterococcus faecalis

“…Meticulous surgical debridement and drainage of the abscess are generally recommended [19–21]. There are some reports of conservative treatment in selected cases of much-extended abscesses or significant surgical risks, but the outcome of conservative treatment is generally poor [22].…”

“…There are some reports of conservative treatment in selected cases of much-extended abscesses or significant surgical risks, but the outcome of conservative treatment is generally poor [22]. A prolonged course of intravenous antibiotics is usually recommended [19, 23]. These are commenced on an empirical basis and later tailored to the isolated pathogen.…”

“…These are commenced on an empirical basis and later tailored to the isolated pathogen. Although the exact duration of antibiotic therapy is not clearly defined, a minimum 3-week course of intravenous antibiotics is usually required [19, 23]. The total duration is related to the improvement of clinical image, radiographic findings and decrease in WBC count and inflammatory markers and ranges between 3 and 16 weeks [19, 23].…”