Immunocompromised patients with subdural spinal abscess

Abstract

Purpose: Background: Subdural spinal abscess is a rare pathology, the cause of which is generally found to be Staphylococcus Aureus, mostly affecting the thoraco-lumbar part of the vertebral column. RM is a means of diagnosing the pathology. We will be presenting the medical case of a diabetic patient with a paraspinal abscess in the lumbar region of the vertebral column. Methods & Materials: Case overview:46 y.o. and has been diagnosed with Mellitus Diabetes. He came to our emergency room disoriented, with a high fever, and nuchal rigidity. Results: Five days history of fever and lower back ache. After the initial examination, a CT scan of his head was conducted; seeing that it did not show an issue, we went through with the lumbar drilling, the result of which showed an abundance of polymorphonuclear and bacteria, which turned out to be Staphylococcus Aureus. Through an RM we were able to detect intraspinal abscesses on the levels of L3 to L5 with inflammatory differences on the parasternal muscles. Inflammation of the Posterior Dura with the aspect of Epiduritis. Arachnoidal cyst spreading from T8-T11, accompanied by a compression of the Spinal Medulla. The patient was treated with Vancomycin and Insulin-therapy. The patient recovered 37 days later. Review of the information: including our patient, there are 66 documented and published cases of the paraspinal abscess. After reviewing these cases we conclude that: The main cause in 34 cases is Staphylococcus Aureus. The most frequent affected area is the lumbar region. The patients are mostly 60 to 70 years old, but the vast majority of them have one or more of these predisposing factors: mellitus diabetes, chronic etilism, tumour, HIV, or abnormalities of the vertebral column. An outline of the clinical events:1.Fever and pain2.fever, lower back pain, and neurological deficits3.total paralysis below the abscess CT and RM scans are used in the placing of the diagnosis. The treatment depending on the different stage of the illness includes therapy with antibiotics and/or surgical drainage. Conclusion: Even though the patient was immunocompromised, the early diagnosis and the immediate therapy brought about the healing of the patient.