Catastrophic Intramedullary Abscess Caused by a Missed Congenital Dermal Sinus

Abstract

Congenital dermal sinus (CDS) is a type of occult spinal dysraphism characterized by a midline skin dimple. A 12-month-old girl presented with fever and ascending quadriparesis. She had a midline skin dimple in the upper sacral area that had been discovered in her neonatal period. Imaging studies revealed a holocord intramedullary abscess and CDS. Overlooking CDS or misdiagnosing it as benign sacrococcygeal dimple may lead to catastrophic infection and cause serious neurological deficits. Therefore, further imaging work-up or consultation with a pediatric neurosurgeon is recommended following discovery of any atypical-looking dimples in the midline.

Spinal intramedullar cord abscess which developed as a result of congenital spinal dermal sinus

“…In some cases reported in literature, full recovery has been reported, while in 20% there has not been full recovery [4]. It has been reported that neurological recovery could be related to the rate and level of intramedullary involvement and the time of diagnosis and surgery [2]. Delays in Figure 1.…”

“…The complication of Several authors have recommended early surgery for these patients [1,2,4]. Drainage of the abscess with laminectomy and dorsal midline myelectomy is an effective method for the control of infection and functional recovery [2]. Laminectomy at multiple levels is not recommended as the risk of later stage complications is increased [8].…”

“…In the current case, diagnosis was not made until the age of 18 months and the patient had been given several antibiotic treatments as there was redness, swelling and discharge in the lumbosacral region and the onset of fever 40 days prior to presentation. The complication of Several authors have recommended early surgery for these patients [1,2,4]. Drainage of the abscess with laminectomy and dorsal midline myelectomy is an effective method for the control of infection and functional recovery [2].…”

“…The incidence of CSDS has been reported as 1 per 2500 births at similar rates for both genders. It may be seen in any location from the occipital region to the coccyx, although it is observed most often in the lumbar and sacral regions [1,2]. There may be accompanying skin colour change, increased hairiness or sacral dimple and the most evident sign is a sinus orifice on the skin.…”

A Case of Tubercular Intramedullary Abscess in An Infant

“…Therefore whenever a dermal sinus is noted in a new born baby possibility of spinal dysraphism has to be ruled out and treated accordingly before it creates a catastrophic infection of the spinal cord. 4 CDS is the commonest cause of intramedullary spinal cord abscess. 5 Hear we present an infant with intramedullary abscess presented with paraparesis and bowel and bladder involvement.…”