A Girl with Life Threatening Meningitis Caused by an Infected Dermoid Cyst Derived from an Occult Dermal Sinus

Valentina Tono,Andrea Biondi,Francesco Canonico,Carlo Giussani,Sara Bertoletti,Maria Luisa Melzi,Francesca Maltese,Erik Sganzerla

doi:10.4236/crcm.2014.38099

Abstract

Congenital dermal sinuses are a rare entity of spinal dysraphism. Most patients have cutaneous markers of their presence, including nevus or port wine stains, dimple, hypertrichosis and subcutaneous lipoma. Inclusion tumors, such as dermoid tumor, are associated to dermal sinus tract; they are congenital, benign and slow-growing lesions of midline. Their clinical relevance is due to the possibility of causing infection, spinal abscess, signs of corde or nerve root compression. Spinal Magnetic Resonance Imaging (MRI) is the diagnostic tool of choice. We present the case of a child with atypical meningitis, resistant to large spectrum antibiotic therapy, caused by an infected dermoid cyst, undiagnosed in the first months of life despite repeated MRI.

Highlights

Congenital dermal sinuses are a rare entity of spinal dysraphism usually located at the lumbar or lumbosacral region [1]
Dermal sinus tracts are rare congenital midline malformations derived from abnormal neurulation
Their presence is often associated with other skin markers of cutaneous dysraphism, such as subcutaneous lipomas, tails, localized hypertrichosis, hyperpigmented or vascular lesions, deviation of the gluteal furrow, dimples [11] [15] [16]

Summary

Introduction

Congenital dermal sinuses are a rare entity of spinal dysraphism usually located at the lumbar or lumbosacral region [1]. Neural tube defects are among the most common congenital abnormalities that result in significant infant morbidity and mortality, affecting one in every 1000 pregnancies in US and developed countries [5] [6]; occult spinal dysraphisms (OSD) are much less common, in particularspinal dermal sinus tract occurs in approximately one in every 2500 live births [7]. Diagnosis and intervention are believed to improve outcome in almost all cases [12] Management of these children needs multidisciplinary approaches; complete clinical evaluation and appropriate investigations are necessary [13], and MRI is the gold standard imaging modality [14]. We describe the case of a 3 years old girl with meningitis, non responding to wide spectrum antibiotics, caused by a dermoid cyst infection resulting from a dermal sinus with a negative early proper evaluation by repeated MRI

Case Description

Findings

Discussion