Van Winter J T, Nielsen S N, Ogburn P L
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1991 Oct;66(10):1036-9. doi: 10.1016/s0025-6196(12)61727-3.
The association between intravenous drug abuse and epidural abscess is well known; however, this association has not previously been reported in a pregnant patient. The classic manifestation of epidural abscess is a febrile patient with back pain that progresses rapidly to radicular pain, spinal cord dysfunction, weakness, and then complete paralysis. Although this condition is rare during pregnancy, these serious complications necessitate prompt diagnosis and intervention. If spinal infection is suspected, magnetic resonance imaging should be performed immediately. After epidural abscess is diagnosed, emergent decompressive laminectomy and appropriate antibiotic coverage are necessary. Herein we describe a 27-year-old pregnant patient with epidural abscess probably related to use of contaminated needles for intravenous administration of drugs and subsequent hematologic spread of staphylococci to the epidural space. The differential diagnosis of epidural abscess can be difficult, and management options must consider the well-being of both the mother and the fetus.
静脉药物滥用与硬膜外脓肿之间的关联众所周知；然而，此前尚未有关于孕妇出现这种关联的报道。硬膜外脓肿的典型表现是发热伴背痛的患者，疼痛迅速进展为神经根性疼痛、脊髓功能障碍、无力，随后发展为完全瘫痪。尽管这种情况在孕期很少见，但这些严重并发症需要及时诊断和干预。如果怀疑有脊柱感染，应立即进行磁共振成像检查。诊断出硬膜外脓肿后，紧急进行减压性椎板切除术并给予适当的抗生素治疗是必要的。在此，我们描述了一名27岁的孕妇，其硬膜外脓肿可能与使用受污染的针头进行静脉药物注射以及随后葡萄球菌经血行播散至硬膜外间隙有关。硬膜外脓肿的鉴别诊断可能很困难，治疗方案必须兼顾母亲和胎儿的健康。
