Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literature
Spinal epidural abscesses (SEAs) are unusual bacterial infections, with possible devastating neurologic sequelae. Despite abundance of case series in adults, reports in children are scanty. We describe a spontaneous SEA due to methicillin susceptible Staphylococcus aureus (MSSA) in a previously heal...
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| Format: | Article |
| Language: | English |
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Elsevier
2015-01-01
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| Series: | IDCases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S221425091500030X |
| _version_ | 1818913270029877248 |
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| author | Alessandra Vergori Alfonso Cerase Lucia Migliorini Maria Grazia Pluchino Giuseppe Oliveri Umberto Arrigucci Andrea De Luca Francesca Montagnani |
| author_facet | Alessandra Vergori Alfonso Cerase Lucia Migliorini Maria Grazia Pluchino Giuseppe Oliveri Umberto Arrigucci Andrea De Luca Francesca Montagnani |
| author_sort | Alessandra Vergori |
| collection | DOAJ |
| description | Spinal epidural abscesses (SEAs) are unusual bacterial infections, with possible devastating neurologic sequelae. Despite abundance of case series in adults, reports in children are scanty.
We describe a spontaneous SEA due to methicillin susceptible Staphylococcus aureus (MSSA) in a previously healthy 15-year old male, and we perform a literature review regarding management of pediatric SEAs without risk factors, from 2001 to 2014.
We found a total of 12 cases (8 males, average age 9.6 years). Clinical presentation was mainly fever, back pain and elevation of inflammation markers. All cases were initially misdiagnosed. Lumbar puncture was performed in 36% of patients. Etiological diagnosis was obtained in 8 cases. MSSA was isolated in 4 patients, methicillin-resistant S. aureus in 1 patient, and S. aureus with unknown susceptibility patterns in 2 cases. The average of therapy duration was 6 weeks. Patients’ spine was always evaluated by gadolinium-enhanced magnetic resonance imaging; most abscesses were localized at thoracic and lumbar area, without osteomyelitis. In 8 cases, laminectomy and/or abscess drainage were performed in association with medical therapy; 3 cases were successfully treated with antimicrobial therapy only; no data were available in one case. A good outcome was obtained in all patients, except a reported residual headache and paraspinal pain lasting for 3 years.
The rarity and the possible differential diagnosis can lead to underestimate SEA occurrence in children without risk factors. It seems therefore essential to maintain a high attention to pediatric SEAs. A prompt diagnosis and adequate therapy are essential prognostic factors for remission. |
| first_indexed | 2024-12-19T23:27:49Z |
| format | Article |
| id | doaj.art-271242e398e4466a87926c3fea38a71b |
| institution | Directory Open Access Journal |
| issn | 2214-2509 |
| language | English |
| last_indexed | 2024-12-19T23:27:49Z |
| publishDate | 2015-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | IDCases |
| spelling | doaj.art-271242e398e4466a87926c3fea38a71b2022-12-21T20:01:48ZengElsevierIDCases2214-25092015-01-012410911510.1016/j.idcr.2015.09.008Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literatureAlessandra Vergori0Alfonso Cerase1Lucia Migliorini2Maria Grazia Pluchino3Giuseppe Oliveri4Umberto Arrigucci5Andrea De Luca6Francesca Montagnani7University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena, ItalyUnit of Neuroimaging and Neurointervention, Hospital Department of Neurological and Sensorial Sciences, University Hospital of Siena, Siena, ItalyUniversity Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena, ItalyUnit of Neurosurgery, Hospital Department of Neurological and Sensorial Sciences, University Hospital of Siena, Siena, ItalyUnit of Neurosurgery, Hospital Department of Neurological and Sensorial Sciences, University Hospital of Siena, Siena, ItalyUnit of Neuroimaging and Neurointervention, Hospital Department of Neurological and Sensorial Sciences, University Hospital of Siena, Siena, ItalyUniversity Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena, ItalyUniversity Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena, ItalySpinal epidural abscesses (SEAs) are unusual bacterial infections, with possible devastating neurologic sequelae. Despite abundance of case series in adults, reports in children are scanty. We describe a spontaneous SEA due to methicillin susceptible Staphylococcus aureus (MSSA) in a previously healthy 15-year old male, and we perform a literature review regarding management of pediatric SEAs without risk factors, from 2001 to 2014. We found a total of 12 cases (8 males, average age 9.6 years). Clinical presentation was mainly fever, back pain and elevation of inflammation markers. All cases were initially misdiagnosed. Lumbar puncture was performed in 36% of patients. Etiological diagnosis was obtained in 8 cases. MSSA was isolated in 4 patients, methicillin-resistant S. aureus in 1 patient, and S. aureus with unknown susceptibility patterns in 2 cases. The average of therapy duration was 6 weeks. Patients’ spine was always evaluated by gadolinium-enhanced magnetic resonance imaging; most abscesses were localized at thoracic and lumbar area, without osteomyelitis. In 8 cases, laminectomy and/or abscess drainage were performed in association with medical therapy; 3 cases were successfully treated with antimicrobial therapy only; no data were available in one case. A good outcome was obtained in all patients, except a reported residual headache and paraspinal pain lasting for 3 years. The rarity and the possible differential diagnosis can lead to underestimate SEA occurrence in children without risk factors. It seems therefore essential to maintain a high attention to pediatric SEAs. A prompt diagnosis and adequate therapy are essential prognostic factors for remission.http://www.sciencedirect.com/science/article/pii/S221425091500030XSpinal epidural abscessManagementStaphylococcus aureusChildren |
| spellingShingle | Alessandra Vergori Alfonso Cerase Lucia Migliorini Maria Grazia Pluchino Giuseppe Oliveri Umberto Arrigucci Andrea De Luca Francesca Montagnani Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literature IDCases Spinal epidural abscess Management Staphylococcus aureus Children |
| title | Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literature |
| title_full | Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literature |
| title_fullStr | Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literature |
| title_full_unstemmed | Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literature |
| title_short | Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literature |
| title_sort | pediatric spinal epidural abscess in an immunocompetent host without risk factors case report and review of the literature |
| topic | Spinal epidural abscess Management Staphylococcus aureus Children |
| url | http://www.sciencedirect.com/science/article/pii/S221425091500030X |
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