Anterior Sacral Pyocele With Meningitis: A Rare Presentation of Occult Spinal Dysraphism With Congenital Dermal Sinus

Abstract

The authors describe an interesting case of a hitherto asymptomatic occult spinal defect with a congenital sacral dermal sinus which proved to be the entry point for bacterial meningitis in an otherwise healthy 9-year-old female child. The patient presented with fever and neck stiffness, and a dermal sinus in the lumbosacral region was identified on examination. Cerebrospinal fluid analysis confirmed bacterial meningitis and a spinal magnetic resonance imaging scan revealed a dermal sinus tract with an anterior spinal meningocele, caudal regression syndrome, and a tethered spinal cord. In addition to administration of intravenous antimicrobial agents, surgical exploration of the sacral dermal sinus tract was performed and an anterior sacral pyocele was drained. The pyocele cavity was disconnected from the thecal sac, and the thickened and fatty filum terminale was sectioned. Although congenital sacral dermal sinus manifesting as bacterial meningitis is known, the occurrence of an anterior sacral pyocele has not yet been described in children.

Skin dimples

“…), especially if any discharge is observed or reported. Such dimples are the hallmark of dermal sinus tracts that predispose the patient to bacterial meningitis or intraspinal abscess . Surgical intervention is aimed at untethering the spinal cord and removing abnormal tissue, when present.…”