Dermal sinus secondary to spinal abscess

Abstract

A 19-month-old female patient was brought into our clinic because of fever (over 39°C) for 17 days, as well as vomiting and weakness which were not resolved by antibiotherapy. On physical examination, respiration sounds were rough and a dimple was detected on the skin at the sacral level. Acute phase reactants were found higher on blood analysis and the patient had no history of chronic disease. Upon development of quadriplegia and glob vesicle on the second day of hospitalization, contrast thoracolumbar magnetic resonance imaging and contrast abdominal computed tomography for etiology of fever were performed. The contrast abdominal computed tomography showed hypodense abscess formations extending from the lower lumbar level to the sacrum with a peripheral contrast uptake, and a dermal sinus tract extending to the skin at the sacral level with dural contrast. Furthermore, the urinary bladder was hydropic (Fig. 1). The contrast thoracolumbar magnetic resonance imaging, on enhanced sagittal T1-weighted imaging, showed multiple abscesses presenting peripheral contrast uptake extending from the lower thoracic level to the sacrum, as well as diffuse contrast uptake on dural surfaces and neural roots, whereas on sagittal T2-weighted imaging significant expansion in the spinal canal was noted (Fig. 2).Based on these findings, the patient was diagnosed with spinal intramedullary abscess due to dermal sinus and dural infection. Fig. 2(Left) There is increased signal intensity and expansile spinal cord on sagittal T2-weighted image. (Middle and Right) There is peripheral enhanced abscess cavity on enhanced sagittal T1-weighted images. View Large Image Figure Viewer Download Hi-res image