Aguilar-Shea A L, Molino-González A M, Gallardo-Mayo C, Pedradas-Navas J M
Servicio de Medicina Interna, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Spain.
Can J Urol. 2008 Aug;15(4):4186-90.
Spinal epidural abscess is an infectious disorder with high morbidity and mortality rates, which is often associated with delayed diagnosis. We report a case of a 73-year-old man with cervical pyogenic spondylodiscitis complicated with epidural abscess following a prostatic biopsy. Clinical presentation included fever, malaise, neck rigidity in all axes, minor paresis of the right arm, and gait ataxia. A cervical vertebral magnetic resonance imaging (MRI) scan showed pyogenic spondylodiscitis with an epidural abscess. Blood, urine, and cerebrospinal fluid cultures were sterile. The patient was treated with intravenous vancomycin, metronidazole, and ceftazidime for 4 weeks, and was discharged from the hospital and treated with oral cloxacillin, metronidazole, and cefixime for another 2 weeks. His neurological symptoms disappeared completely, and he walked normally, without support. It is important for clinicians to be alert to symptoms accompanying back pain following a prostatic biopsy and to consider the possibility of a diagnosis of spinal abscess.
脊柱硬膜外脓肿是一种发病率和死亡率都很高的感染性疾病,常与诊断延迟相关。我们报告一例73岁男性病例,该患者在前列腺活检后发生颈椎化脓性脊椎间盘炎并发硬膜外脓肿。临床表现包括发热、全身不适、各轴向颈部僵硬、右臂轻度无力和步态共济失调。颈椎磁共振成像(MRI)扫描显示化脓性脊椎间盘炎伴硬膜外脓肿。血液、尿液和脑脊液培养均无菌。患者接受静脉注射万古霉素、甲硝唑和头孢他啶治疗4周,出院后继续口服氯唑西林、甲硝唑和头孢克肟治疗2周。他的神经症状完全消失,无需支撑即可正常行走。临床医生必须警惕前列腺活检后伴随背痛的症状,并考虑脊柱脓肿的诊断可能性。