Extensive Epidural Abscess Research Articles

Spontaneous extensive spinal epidural methicillin-resistant Staphylococcus aureus (MRSA) abscess at the level of the cervical and thoracic area in a 21-year-old female: A case report

Spinal epidural abscess is a rare but potentially devastating condition. It usually spans 3 to 4 spinal levels and is associated with patients in an immunocompromised state. We report a case of a 21-year-old Filipino female who presented with high-grade fever, severe nuchal, and upper back pain later associated with progressive ascending numbness and weakness of the lower extremities and bladder and bowel disturbance, related to a furuncle in the right elbow. Contrast-enhanced magnetic resonance imaging showed peripherally enhancing fluid collections in the cervicothoracic paraspinal regions consistent with an extensive epidural abscess. Blood and paravertebral tissue culture were positive for methicillin-resistant Staphylococcus aureus. She underwent a T1-T3 and T5 laminectomy with the evacuation of the abscess followed by an 8-week antibiotic regimen which provide improvement in symptoms. Currently, she is undergoing physical and occupational therapy. To our awareness and with consideration for its rarity, this is the first Filipino case of extensive spinal epidural methicillin-resistant S aureus abscess in an HIV seronegative individual.

An Epidural Abscess Complicating an Infectious Endocarditis: Case Report

Infective endocarditis is responsible of high intra-hospital morbidity and mortality rates. This can be explained partially by the diversity of its complications, which are often difficult to diagnose and manage therapeutically. We report the case of a 63-year-old woman, admitted to the intensive care unit for a sepsis due to infective endocarditis. On her second day of admission, she presented rapidly worsening paraparesis that leaded to flaccid paraplegia, for which she underwent a spinal MRI showing an extensive epidural abscess from T8 to T12 with spinal cord compression. The patient benefited from an emergency laminectomy, and the intraoperative bacteriological sample found the same germ isolated in the blood cultures (staphylococcus aureus methicillin sensitive). This case report emphasizes the importance of clinical and paraclinical evaluation of patients with infective endocarditis, in order to detect complications as early as possible, because if unnoticed, their management become very delicate.

Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review.

Epidural injections are frequent and safe procedures. Severe complications are infrequent, and they have been reported in elderly comorbid patients with predisposing factors. The objectives of this work are to present a case of an extensive epidural lumbar abscess in a young non-comorbid male patient after a therapeutic L5-S1 injection and a literature review about this subject. An otherwise healthy 24-year-old man who present a case of an extensive epidural lumbar abscess after a therapeutic nerve root block due to a disc herniation. After 7 days of fever and low back pain, he required two surgical interventions and intravenous antibiotic therapy. We reviewed 18 patients with epidural abscess consequence of spinal injections. Their mean age was 54.5 y.o, 66.5% were male, and 66.5% had at least one predisposing risk factor. Symptoms Onset occurred at 8 days on average after the procedure, but the correct diagnosis was made at the 25th-day average. Only 22% presented the classic diagnostic triad, the most frequently isolated germ was Staphylococcus Aureus (66%) and 89% were treated surgically with a 33% rate of complete recovery, 17% mortality and 28% remained with neurological sequelae. Epidural abscesses are infrequent and serious, complication after spinal diagnostic and therapeutic injections, even in young patients without comorbidities. We consider it fundamental to maintain a diagnostic suspicion, even in this subgroup of patients.

Spontaneous Pan-Vertebral Epidural Abscesses Caused by Streptococcus Intermedius in an Immunocompetent Patient

Spinal epidural abscess (SEA) is a rarely reported condition. Here, we present a unique case of a 54-year-old immunocompetent man who developed worsening lower back pain of 2 weeks duration. A full spine magnetic resonance imaging (MRI) was performed with contrast. This showed extensive epidural abscess extending from C2 to S2, more extensive around L5-S2, with left paraspinal, left iliopsoas and right psoas abscess confirming the diagnosis of spinal epidural abscess of the spine. Blood cultures grew Streptococcus intermedius, an anaerobic commensal bacterium of the normal flora of the mouth and upper airways. The patient was treated conservatively with intravenous Ceftriaxone 2g and oral Rifampicin 600mg. He was discharged on those medication for 10 weeks. There was remarkable improvement in his symptoms as he retained his baseline strength in his lower extremity and has regained function to the extent that he is independent with his activities of daily living. A high index of clinical suspicion and a low threshold of appropriate imaging, magnetic resonance imaging (MRI) being the gold standard, are important for accurate diagnosis. Though our patient was treated Medically, Prompt medical and surgical treatment may avert complications, and although the patient presented made a complete recovery, patients may be left with neurological deficits.

A case of extensive epidural abscess concomitant with intracranial involvement due to Staphylococcus aureus successfully treated with ceftriaxone in combination with linezolid and rifampin.

A case of extensive epidural abscess concomitant with intracranial involvement due to Staphylococcus aureus successfully treated with ceftriaxone in combination with linezolid and rifampin.

Extensive Craniocervical Abscess after Transoral Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion for Atypical Trigeminal Neuralgia: Report of a Severely Complicated Case

Ganglionic local opioid analgesia (GLOA) describes the application of low-dose opioids close to sympathetic as, for example, to the superior cervical ganglion. GLOA can be effective in different pain syndromes affecting the head and face region and has been considered to be a safe technique with few complications reported so far. We present the case of a patient who received a single, transoral GLOA for a refractory trigeminal neuralgia. The patient subsequently developed an extensive epidural abscess at the craniocervical junction, requiring ultimately transoral odontoid resection and dorsal stabilisation. This severe complication challenges the role of transoral infiltration therapies in analgetic medicine.

A case report of extensive epidural abscess

A case report of extensive epidural abscess

Paraspinal and Extensive Epidural Abscess: The Great Masqueraders of Abdominal Pain.

Paraspinal and epidural abscesses are rare conditions often diagnosed later in the disease process that can have significant morbidity and mortality. Predisposing risk factors include diabetes, human immunodeficiency virus, intravenous drug abuse, and previous history of spinal surgery or injection. They can threaten the spinal cord by compressive effect, leading to sensory motor deficits and ultimately paralysis and death. Diagnosis may be a challenge due to the delayed presentation of nonspecific back pain or radicular pain such as chest pain or abdominal pain. We present a rare case on a patient with periumbilical pain, constipation, and urinary retention who was ultimately diagnosed with a paraspinal abscess extending into the epidural space from T1 to S2. He underwent decompressive laminectomy with incision and drainage of the abscesses. The patient made an excellent recovery postoperatively, and repeat magnetic resonance imaging at six weeks showed resolution of the abscess.

Triparesis caused by gas-containing extensive epidural abscess secondary to Aeromonas hydrophila infection of a thoracic vertebroplasty: a case report

Background contextAeromonas hydrophila is a motile gram-negative non-sporeforming rod with facultative anaerobic metabolism. Except for gastrointestinal disease, skin and soft-tissue infections represent the second most common site of human Aeromonas infections. However, to our knowledge, A. hydrophila infection of the spine has not been reported to date. PurposeTo report the first case of A. hydrophila spinal infection of the T7 vertebra after vertebroplasty. Study designCase report. MethodsA 72-year-old man was transferred to our emergency department with chief complaints of severe midthoracic pain and triparesis. He had undergone vertebroplasty for a painful vertebral fracture at T7 5 weeks before transfer. Magnetic resonance imaging showed an infection of the T7 vertebroplasty and an extensive epidural abscess. The epidural abscess originating from the infected T7 vertebroplasty extended from the T8 to the C4 epidural space. Computed tomography demonstrated sparsely scattered gas in the epidural abscess, strongly suggestive of an anaerobic infection. ResultsEmergency multilevel laminectomies from C5 to T8 and a posterior instrumentation from T3 to T10 were performed. A. hydrophila was isolated from the blood cultures. The patient was treated with intravenous ampicillin/sulbactam. Posterior decompression and stabilization in combination with appropriate antibiotic treatment completely resolved the neurologic deficit and infection without the need for further anterior corpectomy of the infected T7 vertebroplasty. ConclusionsThis is the first reported case of spine infection caused by A. hydrophila. The infection developed after vertebroplasty for the management of a painful vertebral fracture. Triparesis occurred rapidly due to an extensive epidural abscess containing gas. Emergency decompression and stabilization in combination with appropriate antibiotic treatment achieved a successful clinical outcome.

Successful Treatment of Extensive Epidural Abscess with a Percutaneously Introduced Catheter for Drainage

Antimicrobial therapy has been advocated as the treatment for spinal epidural abscesses in patients without neurologic symptoms. However, in the face of neurologic deterioration, surgical management is often utilized because of the risk of further neurologic compromise. Clinical scenarios that may preclude surgical decompression are poor surgical candidates and patients with massive panspinal abscesses. In such instances, percutaneous drain placement may be a viable option.

Successful Use of Daptomycin and Linezolid, Without Surgical Intervention, in the Treatment of Extensive Epidural Abscess and Bacteremia Due to Methicillin-Resistant Staphylococcus aureus (MRSA)

Spinal epidural abscess infections have traditionally been treated with surgical drainage followed by prolonged administration of antibiotics. We present a case of multifocal methicillin-resistant Staphylococcus aureus infection in a patient with an extensive spinal epidural abscess spanning 11 vertebral bodies, bacteremia, left lower extremity cellulitis, and pneumonia. The infection resolved with combination antimicrobial therapy with daptomycin and linezolid and without drainage of the epidural abscess.

Extensive epidural abscess treated with a thoracic laminoplasty

We present a case of a 38-year-old female whom presented to our Service with several days history of back pain and rapidly deteriorating neurologic examination after recently delivering a baby. She had an epidural catheter placed during childbirth that was removed. Further questioning revealed that she had been an extensive intravenous drug abuser before her admission. She began to have unremitting low back pain 3 days later, with the development of neurologic deterioration rapidly with Grade 3–4/5 muscle strength testing in all lower extremity motor groups.

感染性心内膜炎に広範囲硬膜外膿瘍を合併した１例

感染性心内膜炎に広範囲硬膜外膿瘍を合併した１例

From Congenital Dermal Sinus Tract to Extensive Epidural Abscess of the Spine

This is the first report of a large epidural abscess ranging from the cervical to the lumbosacral spine in a child with a very short history of clinical symptoms and a previous history of imperforate anus. A 2-year-old boy presented with a history of fever and fatigue for 5 days. The last two days, he was unwilling to walk or lie on his back. His parents reported on diarrhea with diaper dermatitis followed by the onset of fever. In his past history, the boy underwent a posterior sagittal anorectoplasty for an imperforate anus with a rectourethral fistula two years prior to the current presentation, and an inconspicuous sacral dermal sinus tract (DST) was diagnosed, but he had not yet undergone surgery.

Holocord Spinal Epidural Abscess

Spinal epidural abscess is rare in infants and leads to major permanent neurological deficits if the condition is left untreated. Holocord epidural abscess is extremely rare. We report a patient with methicillin-resistant Staphylococcus aureus septicemia presenting with pneumonia, retroperitoneal abscess, and epidural abscess. A 7-month-old previously healthy girl presented with fever, irritability, tachypnea for 4 days and decreased movement of the right lower limb for 1 day. Magnetic resonance imaging of the spine demonstrated an extensive epidural abscess from second cervical to fifth lumbar vertebrae without osteomyelitis or discitis. The epidural abscess was treated with intravenous antibiotics for 6 weeks. At 3 months follow-up, no neurological deficits were present. Only a few case reports of holocord epidural abscess in children have been published. We present a case of conservatively treated holocord spinal abscess in an infant.

Methicillin-resistant Staphylococcus aureus (MRSA) mitral valve acute bacterial endocarditis (ABE) in a patient with Job’s syndrome (hyperimmunoglobulin E syndrome) successfully treated with linezolid and high-dose daptomycin

Job's syndrome (hyperimmunoglobulin E syndrome) is a congenitally acquired primary immune deficiency. The primary host defense defect in Job's syndrome is impaired phagocytosis. Accordingly, patients with Job's syndrome have difficulties eradicating staphylococcal infections. A continuous, high-grade Staphylococcus aureus bacteremia with a cardiac valve vegetation is the hallmark of S. aureus acute bacterial endocarditis (ABE). ABE may be caused by methicillin-sensitive Staphylococcus aureus or methicillin-resistant Staphylococcus aureus (MRSA). We report a case of Job's syndrome MRSA mitral valve ABE. Presumably because of impaired phagocytic function, his MRSA ABE was complicated by extensive metastatic septic complications manifested as brain abscess, multiple epidural abscesses, and multifocal vertebral osteomyelitis. The patient did not respond to 5 days of appropriately dosed linezolid and daptomycin and remained bacteremic because abscess drainage was not an option in this case and the continuous, high-grade MRSA bacteremia continued despite appropriate therapy. High-dose daptomycin (12 mg/kg intravenously every 24 hours) was given, and his MRSA bacteremia was rapidly terminated. Because daptomycin does not cross the blood-brain barrier in therapeutic concentrations, linezolid was used to treat the brain abscess. The extensiveness of infection in this case is remarkable and is probably related to impaired phagocytic function from Job's syndrome. High-dose daptomycin therapy rapidly cleared the bacteremia and cured the endocarditis and epidural abscesses/vertebral osteomyelitis. The patient was treated with 8 weeks of high-dose daptomycin therapy with no adverse effects. If MRSA and methicillin-sensitive S. aureus bacteremias are unresponsive to usually effective antistaphylococcal agents, and surgical drainage of abscesses and removal of infected devices are not clinically possible, then a prolonged, high dose of daptomycin is a therapeutic alternative in such situations. To the best of our knowledge, this is the first case of MRSA mitral valve ABE complicated by extensive epidural abscesses and vertebral osteomyelitis in a patient with Job's syndrome.

Potential use of spinal canal endoscopy for successful treatment of cauda equina tumour and epidural abscess

AbstractSpinal canal endoscopy is recognised as a new technique for treatment of chronic low back and leg pain due to lumbar epidural adhesions involving nerve roots. In this paper, the cases of two patients who received orthopaedic surgery combined with spinal canal endoscopy are discussed. In case 1, the patient had a cauda equina tumour and underwent extirpation of the tumour assisted by spinal canal endoscopy. In case 2, the patient was suffering from extensive epidural abscess. He was treated with antibiotics and underwent single-level laminectomy and drainage assisted by spinal canal endoscopy. In case 1, small tumours that could not be identified by magnetic resonance imaging were identified with spinal canal endoscopy: the tumours were then partially removed from the T12 vertebral level to the S1 vertebral level by right hemilaminectomy of S1, and laminectomy of L5 and T12. In case 2, the use of spinal canal endoscopy enabled drainage and lavage of the wide lesion of the abscess by the single–leve...

Extensive epidural abscess with surgical treatment and long term follow up

Background context Spinal epidural abscess is an uncommon infection. There are few reports on extensive epidural abscesses. Purpose We report a case of an epidural abscess extending from C2 to the sacrum, with a long-term follow-up. Study design A case report of an extensive epidural abscess with surgical treatment. Methods A 36-year-old male patient presented with a history of 15 days of fever and severe lumbar and neck pain. Magnetic resonance imaging disclosed an epidural abscess extending from C2 to the sacrum. Limited laminectomies were performed in the cervical, thoracic, and lumbar spine, and pus was obtained. A peptostreptococus grew in cultures. The patient received 6 weeks of antibiotics. Results The infection was successfully treated, and no neurological deficit was observed. The patient continued asymptomatic 5 years after surgery, and no deformity has developed. Conclusions A case of an extensive epidural abscess was successfully treated with limited laminectomies and antibiotics. This less invasive technique could treat the infection, and no late deformity has been observed.

Bone and joint infection due to Streptococcus pneumoniae in two immunocompetent adults

Bone and joint infections due to Streptococcus pneumoniae are uncommon in adults in the absence of risk factors (e.g. alcohol abuse, immunodepression, or preexisting joint disease). We report two cases in previously healthy adults. The clinical picture was septic arthritis of the knee in one patient and discitis with an extensive epidural abscess in the other. The characteristics of S. pneumoniae bone and joint infections are reviewed, with emphasis on risk factors. The therapeutic strategy is discussed in the light of the recent upsurge in S. pneumoniae strains with reduced susceptibility to penicillin.

Extensive Spinal Epidural Abscess Associated with an Unremarkable Recovery

Spinal epidural abscess is a rare complication of epidural catheter insertion, with an incidence reported to be as low as 0.02%, but with a high morbidity and mortality. This reflects the difficulty in diagnosis of the condition, as early symptoms and signs are usually non-specific with late neurological manifestations. We report a case of spinal epidural abscess in a diabetic patient who underwent splenectomy and distal pancreatectomy. Early investigation with magnetic resonance imaging was effective in demonstrating an extensive epidural abscess involving the thoracic spine, with extension to the base of the skull and associated cord compression. Extensive multilevel laminectomies with thorough irrigation and washout of the epidural space were successful in treating this patient and preventing the development of permanent neurological sequelae.