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Mixed pyogenic and tuberculous spinal epidural abscesses perforating the dura and extending into the subdural space: A case report and review of the literature.
Almotairi, Fawaz S; Alsaleh, Alwaleed Abdulrahman; Basalamah, Ali A; Mallat, Mohannad M; Babateen, Emad M; Abdu, Ali; Bahabri, Saeed O.
Afiliación
  • Almotairi FS; Department of Neurosurgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
  • Alsaleh AA; Medical Intern, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
  • Basalamah AA; Department of Neurosurgery, King Saud University Medical City, Riyadh, Saudi Arabia.
  • Mallat MM; Medical student, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
  • Babateen EM; Medical student, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
  • Abdu A; Department of Radiology, King Saud University Medical City, Riyadh, Saudi Arabia.
  • Bahabri SO; Department of Pathology, King Saud University Medical City, Riyadh, Saudi Arabia.
Surg Neurol Int ; 14: 315, 2023.
Article en En | MEDLINE | ID: mdl-37810309
ABSTRACT

Background:

Spinal infections are associated with a wide variety of clinical conditions, including osteomyelitis, spondylitis, diskitis, septic facet joints, and abscesses. Based on its anatomical relationship with the dura mater, the abscess can be epidural (extradural) or subdural (intrathecal). Subdural intramedullary abscesses of the lumbar spinal canal are more common than subdural extramedullary abscesses. Here, we present a rare case of a patient with a mixed pyogenic and tuberculous epidural abscess in the lumbar spine, which perforated the dura and extended to the subdural space. Case Description A 29-year-old male presented with progressively worsening back pain and lower-limb weakness over a period of 3 months, with an associated inability to walk, intermittent radicular pain primarily on the left side, intermittent incontinence, and a history of low-grade fever and night sweats. The patient had a history of intravenous (IV) drug abuse and reported practicing unprotected sexual intercourse. Furthermore, the patient had recently came into contact with a person diagnosed with tuberculosis (TB). The patient was administered empirical broad-spectrum antibiotics and underwent emergent L4-L5 laminectomy and spinal abscess decompression. IV antibiotics were selected based on culture results, and anti-TB medications were started. Postoperatively, the patient demonstrated a remarkable lower-limb power improvement and radicular pain alleviation.

Conclusion:

Spinal epidural abscess perforation of the dura and extension into the subdural space is extremely rare. Distinguishing between epidural and subdural abscesses radiologically is challenging. Multiple risk factors, such as unprotected sexual contact and IV drug misuse, may be associated with the development of polymicrobial abscesses in the lumbar spine. Careful anticipation, identification, and isolation of the causative micro-organisms can ensure effective antibacterial treatment. Early diagnosis, expeditious surgical decompression, and antibiotic treatment are associated with promising outcomes.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Prognostic_studies / Risk_factors_studies / Screening_studies Idioma: En Revista: Surg Neurol Int Año: 2023 Tipo del documento: Article País de afiliación: Arabia Saudita

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Prognostic_studies / Risk_factors_studies / Screening_studies Idioma: En Revista: Surg Neurol Int Año: 2023 Tipo del documento: Article País de afiliación: Arabia Saudita