Villarejo-Galende A, Camacho-Salas A, Penas-Prado M, Juntas-Morales R, Gonzalez-de la Aleja J, Ramos A, Rodríguez-Vallejo A
Servicio de Nuerología, Hospital Universitario Doce de Octubre, Madrid, España.
Rev Neurol. 2003;36(12):1152-5.
Spinal epidural abscess is a rare entity requiring early diagnosis and treatment. Sepsis is a factor with an unfavourable prognosis.
We report the case of a 57 year old female with acute low back pain who was admitted to hospital suffering from a state of septic shock and multiple organ failure secondary to an infection disseminated by Staphylococcus aureus, which was treated early on with vancomycin. The probable source of infection was assumed to be necrotizing fasciitis of the left arm. Once the acute phase had been overcome, serious paraparesis became apparent and this led to magnetic resonance imaging of the spine being carried out, the results of which showed the existence of a lumbar spondylodiscitis with associated epidural abscess.
In patients with sepsis and some previous symptom that arouses suspicion, it is important to consider this possible diagnosis, since treatment with antibiotics alone does not manage to prevent neurological complications in all cases.
脊柱硬膜外脓肿是一种罕见疾病,需要早期诊断和治疗。脓毒症是预后不良的一个因素。
我们报告一例57岁女性,因急性腰痛入院,因金黄色葡萄球菌播散性感染继发脓毒性休克和多器官功能衰竭,早期用万古霉素治疗。推测感染源可能是左臂坏死性筋膜炎。急性期过后,出现严重的下肢轻瘫,遂进行脊柱磁共振成像检查,结果显示存在腰椎椎体骨髓炎伴硬膜外脓肿。
对于有脓毒症且有可疑既往症状的患者,考虑这一可能诊断很重要,因为仅用抗生素治疗并不能在所有病例中预防神经并发症。