Cargando…

Mixed pyogenic and tuberculous spinal epidural abscesses perforating the dura and extending into the subdural space: A case report and review of the literature

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). S...

Descripción completa

Detalles Bibliográficos
Autores principales: Almotairi, Fawaz S., Alsaleh, Alwaleed Abdulrahman, Basalamah, Ali A., Mallat, Mohannad M., Babateen, Emad M., Abdu, Ali, Bahabri, Saeed O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10559415/
https://www.ncbi.nlm.nih.gov/pubmed/37810309
http://dx.doi.org/10.25259/SNI_536_2023
_version_ 1785117492643889152
author Almotairi, Fawaz S.
Alsaleh, Alwaleed Abdulrahman
Basalamah, Ali A.
Mallat, Mohannad M.
Babateen, Emad M.
Abdu, Ali
Bahabri, Saeed O.
author_facet Almotairi, Fawaz S.
Alsaleh, Alwaleed Abdulrahman
Basalamah, Ali A.
Mallat, Mohannad M.
Babateen, Emad M.
Abdu, Ali
Bahabri, Saeed O.
author_sort Almotairi, Fawaz S.
collection PubMed
description 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.
format Online
Article
Text
id pubmed-10559415
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Scientific Scholar
record_format MEDLINE/PubMed
spelling pubmed-105594152023-10-08 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. Surg Neurol Int Case Report 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. Scientific Scholar 2023-09-08 /pmc/articles/PMC10559415/ /pubmed/37810309 http://dx.doi.org/10.25259/SNI_536_2023 Text en Copyright: © 2023 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Case Report
Almotairi, Fawaz S.
Alsaleh, Alwaleed Abdulrahman
Basalamah, Ali A.
Mallat, Mohannad M.
Babateen, Emad M.
Abdu, Ali
Bahabri, Saeed O.
Mixed pyogenic and tuberculous spinal epidural abscesses perforating the dura and extending into the subdural space: A case report and review of the literature
title Mixed pyogenic and tuberculous spinal epidural abscesses perforating the dura and extending into the subdural space: A case report and review of the literature
title_full Mixed pyogenic and tuberculous spinal epidural abscesses perforating the dura and extending into the subdural space: A case report and review of the literature
title_fullStr Mixed pyogenic and tuberculous spinal epidural abscesses perforating the dura and extending into the subdural space: A case report and review of the literature
title_full_unstemmed Mixed pyogenic and tuberculous spinal epidural abscesses perforating the dura and extending into the subdural space: A case report and review of the literature
title_short Mixed pyogenic and tuberculous spinal epidural abscesses perforating the dura and extending into the subdural space: A case report and review of the literature
title_sort mixed pyogenic and tuberculous spinal epidural abscesses perforating the dura and extending into the subdural space: a case report and review of the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10559415/
https://www.ncbi.nlm.nih.gov/pubmed/37810309
http://dx.doi.org/10.25259/SNI_536_2023
work_keys_str_mv AT almotairifawazs mixedpyogenicandtuberculousspinalepiduralabscessesperforatingtheduraandextendingintothesubduralspaceacasereportandreviewoftheliterature
AT alsalehalwaleedabdulrahman mixedpyogenicandtuberculousspinalepiduralabscessesperforatingtheduraandextendingintothesubduralspaceacasereportandreviewoftheliterature
AT basalamahalia mixedpyogenicandtuberculousspinalepiduralabscessesperforatingtheduraandextendingintothesubduralspaceacasereportandreviewoftheliterature
AT mallatmohannadm mixedpyogenicandtuberculousspinalepiduralabscessesperforatingtheduraandextendingintothesubduralspaceacasereportandreviewoftheliterature
AT babateenemadm mixedpyogenicandtuberculousspinalepiduralabscessesperforatingtheduraandextendingintothesubduralspaceacasereportandreviewoftheliterature
AT abduali mixedpyogenicandtuberculousspinalepiduralabscessesperforatingtheduraandextendingintothesubduralspaceacasereportandreviewoftheliterature
AT bahabrisaeedo mixedpyogenicandtuberculousspinalepiduralabscessesperforatingtheduraandextendingintothesubduralspaceacasereportandreviewoftheliterature