Pilonidal Sinus as a Route of Infection in a Case of Staphylococcus Meningitis

Abstract

The occurrence of a pilonidal sinus extending to and communicating with the arachnoid space seems to be of sufficiently rare occurrence to justify a report of such a case. REPORT OF CASEHistory.\p=m-\DeWittde'L., aged 3\m=1/2\months, was referred to the Mountainside Hospital on June 7, 1927, by his private physician, with a diagnosis of pneumonia.The patient was born at term in normal delivery. Constipation had been present in a varying degree since birth, but otherwise he apparently was normal up to two weeks previous to admission to the hospital. At that time, he became fretful. The fretfulness became more pronounced and one week before admission was associated with vomiting and loss of appetite. Two days before admission it was noticed that any attempt to lift the child caused it to scream, in apparent pain, throw its head back and become somewhat rigid. The temperature was said to be high and the respiration rapid. A physician was called who sent the infant to the hospital.Course.-On admission, the temperature was 101.4 F. (39 C.) and the pulse rate, 148. Respirations numbered 48. The child was moderately well nourished but seemed to be acutely ill.The chief complaints were nausea, vomiting, constipation, fever and rapid respiration. The child apparently suffered pain when picked up or moved. The parents were unable to locate this pain. On physical examination, the patient was irritable and cried out in pain when moved. The site of this pain could not be located. An area of consolida¬ tion in the right upper lobe involved practically the whole lobe. A resistance to flexion of the head, which was easily overcome, was noted. The reflexes were not exaggerated, and bulging of the fontanel was not present. The urine showed a faint trace of albumin, a few epithelial cells and a few leukocytes.The second day after admission, a slight stiffness of the neck and a suggestion of Kernig's sign in the right leg were noted. The knee jerks were exaggerated on both sides, but bulging of the anterior fontanel was not present. On the third day, the child's condition seemed better.The fourth day the general condition was about the same, but the child was more excitable. At this time, pus was first noticed at the bottom of a sacrococcygeal dimple. When this pus was wiped away, evidence of inflammation in the skin or deeper tissues could not be found. No orifice was visible at the base of the dimple, but a probe slipped in easily to a distance of about \y2 inches (4 cm.) without encountering any resistance. An x-ray was taken,

Coccygeal Pits

“…25,26 The terminology used for location description is inconsistent and photographic documentation is lacking with these respective reports. The sinuses described in the reports by Ripley and Thompson 25 and by Stammers 26 may actually be located above the natal cleft of the buttocks representative of well-characterized cutaneous signatures of OSD.…”

Spinal Dermoid Tumours

“…After 29 years the patient was admitted to our clinic because reappearance of the purulent secretion from the dermal sinus. Such cases with septic meningitis or abscess brought about by the dermal sinus have been published by Stone (1924), Moishe (1926), Ripley and Thompson (1928), Weeder (1933), Owen (1934), Gross (1934), Hamby (1944), Mount (1949), Petterson et al (1963 etc.…”

The spinal dermal-sinus-like stalk

“…It has been suggested that the separation between surface ectoderm and neural ectoderm did not take place during embryonic development, resulting in an epidermal-neural fistula [9,11,14,18].…”