Zied Mansi, Marouene Berriri, Mokhtar Romdhani, Abdelkader Tounsi, Wajdi Chermiti, Ali Haggui
Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia.
Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia.
Int J Surg Case Rep. 2024 Aug;121:110004. doi: 10.1016/j.ijscr.2024.110004. Epub 2024 Jul 4.
Epidural abscess is a rare but serious infection. Although more commonly seen in men over 50, our case is notable for its occurrence in a pediatric patient, highlighting the unusual nature of this abscess at such a young age, particularly in conjunction with septic arthritis of the hip.
A 10-year-old child was admitted to pediatrics for investigation of a prolonged fever. The child presented with back pain associated with left hip lameness. An MRI of the spine showed an epidural collection extending from the 4th to the 10th dorsal vertebrae. This collection compressed the spinal cord. An MRI of the left hip showed an appearance consistent with septic arthritis. A left hip arthrotomy was performed, with laminectomy and drainage of the epidural abscess at D7. The patient was treated with antibiotics. The clinical and biological evolution was favorable.
Epidural abscess is a rare but serious infection, now more easily diagnosed by MRI. It is most often caused by hematogenous spread, mainly by Staphylococcus aureus. Symptoms include back pain, neurological signs and fever. Diagnosis is confirmed by MRI. Early diagnosis is essential to prevent neurological complications and death, as the disease can progress to paralysis. Treatment consists of intravenous antibiotics and surgical intervention as indicated.
Early diagnosis of spinal epidural abscess is important to prevent neurological complications, sepsis and even death. It should be noted that there are no official recommendations or guidelines for the management of epidural spinal abscesses in the pediatric population.
硬膜外脓肿是一种罕见但严重的感染。虽然在50岁以上男性中更常见，但我们的病例值得注意的是它发生在一名儿科患者身上，凸显了这种脓肿在如此年轻的年龄出现的不寻常性质，特别是与髋关节化脓性关节炎并发时。
一名10岁儿童因长期发热入院儿科进行检查。该儿童表现为背痛伴左髋跛行。脊柱磁共振成像（MRI）显示硬膜外积液从第4至第10胸椎延伸。此积液压迫脊髓。左髋MRI显示表现符合化脓性关节炎。进行了左髋关节切开术，并在第7胸椎进行椎板切除术及硬膜外脓肿引流。患者接受了抗生素治疗。临床和生物学进展良好。
硬膜外脓肿是一种罕见但严重的感染，现在通过MRI更容易诊断。它最常由血行播散引起，主要由金黄色葡萄球菌导致。症状包括背痛、神经体征和发热。MRI可确诊。早期诊断对于预防神经并发症和死亡至关重要，因为该疾病可进展为瘫痪。治疗包括静脉使用抗生素及根据情况进行手术干预。
脊柱硬膜外脓肿的早期诊断对于预防神经并发症、败血症甚至死亡很重要。应当指出，对于儿科人群硬膜外脊柱脓肿的管理尚无官方推荐或指南。
