Abcès intramédullaire chronique (streptococcus sanguis): Cas clinique et revue de la littérature

Abstract

Chronic intramedullary spinal cord abscesses are very rare. We present here a new case of this pathology, revealed by a progressive spinal cord compression. This case is particular because of the long follow up before surgery (two years).This 69-year-old patient presented a gradually progressive paraparesis and sensory loss associated with leg pain. The past medical history was dominated by a epidermoid cancer of the tongue. MRI showed an intramedullary mass at T10. On the T1-weighted sequences, the lesion was isointense with the spinal cord, Gadolinium infusion showed homogeneous enhancement of the lesion. T2-weighted sequences showed decreased signal within the lesion and an increased signal peripherally (edema). Corticosteroid infusions relieved the symptoms so the patient declined surgery. Two episodes of regressive paraplegia were treated by the same infusions. The patient accepted surgery after a third episode.The intervention was performed two years after the first signs and revealed a hard white mass attached to the spinal cord. Pathologic examination showed infectious inflammation. Bacteriological cultures found a Streptococcus sanguis. Two years later the patient could walk; a minimal deficit persists.First, the diagnosis was evoked but not retained because of the long course. The corticosteroid infusions gave relief and did not increase the deficit. The MRI findings remained unchanged. Intramedullary spinal cord abscesses are very rare. This pathology must be recognized because without treatment morbidity is high with a potentially fatal outcome.