Spontaneous Methicillin-Resistant Staphylococcus aureus Epidural Abscess in Pregnancy

Abstract

Spontaneous epidural abscess is a rare condition and diagnosis is often delayed. The finding of Horner syndrome led to imaging of the cervical spine and diagnosis of epidural abscess. Early intervention resulted in resolution of neurologic symptoms and a successful pregnancy outcome.

Pott's puffy tumour and intracranial complications of frontal sinusitis in pregnancy

“…12,13 A small number of spontaneous spinal epidural abscesses in pregnancy have also been reported. [14][15][16][17] Our case represents the first report of Pott's puffy tumour in pregnancy, associated with both orbital and intracranial extension. This case also highlights some of the management dilemmas associated with intracranial complications of sinusitis in pregnancy.…”

“…The other case involved a maxillary and ethmoid sinusitis and temporal lobe abscess in a 36-weeks' gestation woman, managed by caesarean section under spinal anaesthesia and a 4-week course of antibiotics (with no neurosurgical procedure and no bacteria cultured) 12 . Epidural collections in pregnancy occur most commonly as a complication of regional anaesthesia; however, there have been four reported cases of spontaneous spinal epidural abscess in pregnancy, presumably relating to transient bacteraemia and seeding, all of which required emergency laminectomy and decompression 14 – 17 …”

“…12 Epidural collections in pregnancy occur most commonly as a complication of regional anaesthesia; however, there have been four reported cases of spontaneous spinal epidural abscess in pregnancy, presumably relating to transient bacteraemia and seeding, all of which required emergency laminectomy and decompression. [14][15][16][17] A further management dilemma in pregnant patients with an intracranial collection involves the choice of treatment: whether to manage conservatively or surgically, which antibiotic regime to choose, and other issues of timing and induction.…”

“…Two cases of sinogenic brain abscess in pregnancy were identified 12 , 13 . A small number of spontaneous spinal epidural abscesses in pregnancy have also been reported 14 – 17 …”

Spontaneous spinal epidural abscess in pregnancy: a case series

“…Additional risk factors include intravenous drug use (IVDU), diabetes mellitus, immunosuppression, and bacteremia [7,8]. Only eight cases of epidural abscesses during pregnancy unrelated to spinal anesthesia have been reported in the literature, seven of which occurred in the spine and one of which was intracranial [3,[9][10][11][12][13][14][15]. All cases were treated with a combination of antibacterial and surgical therapy [3,[10][11][12][13][14][15] except one that was treated successfully with antibiotic therapy alone [3].…”