Tuberculous lumbar spinal epidural abscess in a young adult (case report).

Ghazwan Abdulla Hasan,Saif Mohammed Kani,Ahmed Alqatub

doi:10.1051/sicotj/2018005

Abstract

Introduction: Spinal Epidural abscess (SEA) is an uncommon pathology that needs an urgent intervention to decompress the pressure on the spinal epidural sac, cord, and roots. The authors report a rare case of a young adult with lumbar spinal epidural tuberculous abscess occupying the spinal canal from L2–L5 vertebrae with extesion to the posterior paraspinal muscles and presenting with bilateral progressive lower limb weakness. Case report: A 42 years old male teacher presented with a 15-day history of progressive difficulty to walking and bilateral lower limb weakness associated with fever, malaise and later on urinary incontinence. A magnetic resonance imaging (MRI) scan revealed a paraspinal intermuscular abscess and an abscess occupying the spinal canal compressing the dural sac from L2–L4/5, without any signs of vertebral involvement. Surgery was done by a posterior midline incision. Pus was evacuated from multiple pockets through the paraspinal muscle layers. Laminectomy for L3/4, and hemilaminectomy for L2/3, and L4/5 were performed. Pus and bone specimens were negative for acid-fast bacilli. However, both histopathological studies and Polymerase Chain Reaction (PCR) testing confirmed the presence of tuberculosis (TB). The patient received TB antibiotics, and a follow-up MRI scan at 2 months showed complete evacuation of the abscess. However, signs of L5 spondylitis were evident. No further surgery was needed as there was no vertebral collapse or neural compression and the patient's clinical condition was improving. He had normal right lower limb power and sensation and grade 4+ motor power of the left lower limb. Bowels and bladder function was normal.Conclusion: Isolated tuberculous spinal epidural abscess is a rare disease and should be treated urgently with evacuation and decompression. Signs of spondylitis or spondylodiscitis may appear later and therefore long follow up is recommended in tuberculous cases presenting with an isolated epidural abscess.

Highlights

Abstract -- Introduction: Spinal Epidural abscess (SEA) is an uncommon pathology that needs an urgent intervention to decompress the pressure on the spinal epidural sac, cord, and roots
A 42 years old male teacher referred to our hospital complaining of the 15-day history of progressive back pain radiating to both thighs
He had a pulse rate of 95 beats per minute, blood pressure 110/70, temperature 38.3 °C, and a respiratory rate of 19 cycles per minute

Summary

Introduction

Abstract -- Introduction: Spinal Epidural abscess (SEA) is an uncommon pathology that needs an urgent intervention to decompress the pressure on the spinal epidural sac, cord, and roots. Case report: A 42 years old male teacher presented with a 15-day history of progressive difficulty to walking and bilateral lower limb weakness associated with fever, malaise and later on urinary incontinence. No further surgery was needed as there was no vertebral collapse or neural compression and the patient’s clinical condition was improving He had normal right lower limb power and sensation and grade 4+ motor power of the left lower limb. A 42 years old male teacher referred to our hospital complaining of the 15-day history of progressive back pain radiating to both thighs He subsequently developed weakness affecting both lower limbs, but mainly on the left side, with urinary incontinence and constipation.

Methods

Findings

Conclusion