Rapidly Progressive Spontaneous Spinal Epidural Abscess

Abstract

Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

Review and case report demonstrate that spontaneous spinal epidural abscesses are rare but dangerous in childhood

“…In our review, blood cultures were positive in 50% of cases. Cultures obtained from the abscesses themselves were positive in 90% of the cases, with Staphylococcus aureus being the most frequently identified pathogen (45–63%) . The most frequent microorganism was Staphylococcus aureus (73%), followed by methicillin‐susceptible Staphylococcus aureus (40%) and Group A Streptococcus (27%).…”

“…There are very few reports of paediatric SEA in the literature . Haematogenous spread from an intercurrent febrile illness, such as tonsillitis, pharyngitis, pneumonia, acute otitis media, skin and soft tissue infections, is the favoured route of infection, especially in infants and young children .…”

Absceso epidural espinal: caso clínico pediátrico

“…Estos son los 3 síntomas más comunes. 1,3,4 Pero esta tríada clásica se presenta rara vez, 5 ya que, habitualmente, el diagnóstico puede ser establecido antes de la aparición de los signos neurológicos.…”

“…D e n t r o d e l o s a g e n t e s e t i o l ó g i c o s , e l Staphylococcus aureus se aísla en alrededor de 66% de los casos. 1,3,10 Se observa un aumento de la prevalencia de Staphylococcus aureus meticilino resistente (SAMR) en niños sin factores de riesgo. 11,12 No obstante, la revisión de la literatura hecha por Auletta et al indica un alto rango de infección por Staphylococcus aureus meticilino sensible, como se observó en nuestra paciente.…”

“…1 Se caracteriza por una colección purulenta que se localiza entre la duramadre y el canal medular. El Staphylococcus aureus es el agente etiológico más frecuente y llega a dicho espacio por extensión directa o diseminación hematógena desde un foco lejano.…”