Bacterial Spinal Epidural and Psoas Abscess in Pregnancy Associated with Intravenous Drug Use

Strauss, Tirtza Spiegel; Pachtman, Sarah; Rochelson, Burton

doi:10.1155/2018/1797421

Cited by 4 publications

(8 citation statements)

References 18 publications

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“…Three case reports describe a primary psoas abscess in spinal tuberculosis, with bilateral psoas abscesses in two of three cases [ 1 – 3 ]. Furthermore, two cases of psoas abscesses associated with drug abuse have been described [ 4 , 5 ]. There is only one case report of a psoas abscess in the setting of Crohn's disease in pregnancy [ 7 ].…”

Section: Resultsmentioning

confidence: 99%

“…Only four cases describe fever, back pain, and pain while moving the ipsilateral leg, defined as the triad of psoas abscess by Hermann Mynter in 1881 [ 3 , 5 , 7 , 8 ]. Our case also shows the difficulty of diagnosis, especially when more common differential diagnoses are in the foreground.…”

Section: Resultsmentioning

confidence: 99%

“…Pathogenic germs such as Staphylococcus aureus or Mycobacterium tuberculosis , but also underlying diseases such as chronic inflammatory bowel diseases or malignancy, are the leading causes. During pregnancy, the main reasons for psoas abscesses are spinal tuberculosis [ 1 – 3 ], drug abuse [ 4 , 5 ] or pyelonephritis [ 6 ]. A psoas abscess in a patient with Crohn’s disease has been described only once [ 7 ].…”

Section: Aimmentioning

confidence: 99%

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Psoas abscess in pregnancy: a review of the literature and suggestion of minimally invasive treatment options

Schröder

Calite

Böckenhoff

et al. 2023

Arch Gynecol Obstet

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Aim Less than a dozen cases of psoas abscesses in pregnancy have been described in the literature. We reviewed the literature when treating a patient with a psoas abscess after ipsilateral double J-ureteral stent placement (in the following: “double J-stent”) due to infected hydronephrosis. Methods In January 2022, this review was searched using the Pubmed/MEDLINE database and the mesh terms “Psoas Abscess” AND “Pregnancy”. Studies were included in any language and of all years, describing a psoas abscess during pregnancy. When patients did not have a psoas abscess, the abscess occurred after pregnancy, or when there was no full text available, the article was excluded. Main results Ten case reports about patients with psoas abscesses during pregnancy were included. The classical symptomatic triad of psoas muscle abscess included lower back pain, limping and persistent fever with daily spikes. However, in most cases, not all three symptoms can be found. Especially, fever is absent in more than half of the patients. Psoas abscesses are described between 13 and 39 weeks of gestation. Primary psoas abscesses with haematogenous spread are more common during pregnancy than secondary with spread per continuitatem. In the literature, the main reasons for psoas abscess are spinal tuberculosis, drug abuse or underlying diseases such as Crohn’s disease. It is not uncommon for the definite cause to be unclear. Regarding the patient's symptoms, pyelonephritis is often considered a possible aetiology. In general, the main treatment options include antibiotic treatment and abscess drainage. There is no higher caesarean section rate, and no negative outcome for the foetus has been described. Case presentation In our patient, a 38-year-old obese Caucasian woman, who had received a left double J-stent for infected hydronephrosis at 15 weeks of gestation, we successfully treated a psoas abscess of 20 × 10 cm with a sonographically assisted abscess drainage and antibiotics. The further course of pregnancy and the elective repeat caesarean section at 38 + 0 weeks of gestation were without any problems. Double J-stent placement and laser stone lithotripsy during puerperium were performed because of recurrent urolithiasis. Conclusions Although rare, psoas abscesses can occur during pregnancy, and it has often been treated surgically in the past. A psoas abscess as a complication after infected hydronephrosis and intervention during pregnancy has never been reported in the literature. Even for obese patients, minimally invasive therapy may be a treatment option that has rarely been reported in the literature.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Aimmentioning

confidence: 99%

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Psoas abscess in pregnancy: a review of the literature and suggestion of minimally invasive treatment options

Schröder

Calite

Böckenhoff

et al. 2023

Arch Gynecol Obstet

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“…Newer data suggest that SEA is increasing in prevalence, accounting for around 1 in 1000 hospitalizations, paralleling a rise in immunocompromised states and intravenous drug use [6]. As previously stated, SEA is most commonly the result of regional anesthesia in the peripartum period [4,5]. Additional risk factors include intravenous drug use (IVDU), diabetes mellitus, immunosuppression, and bacteremia [7,8].…”

Section: Introductionmentioning

confidence: 97%

“…SEA is a rare cause of low back pain in pregnancy. There are few reported cases of SEA occurring during pregnancy, majority of which are complications of epidural analgesia during labor and delivery [4,5]. Studies previously had shown SEA to be the cause of 0.2-1.2 in 10,000 of all hospitalizations.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous spinal epidural abscess in pregnancy: a case series

Robinson

Lewis

Regan

2021

Spinal Cord Ser Cases

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INTRODUCTION: Spontaneous spinal epidural abscess (SEA) is a rare diagnosis; only eight cases have been reported during pregnancy. Diagnosis of SEA can be difficult, especially when the classic triad of fever, back pain, and neurologic deficits are not present. Early diagnosis and treatment are necessary to reduce potential morbidity and mortality. CASE PRESENTATIONS: We report two separate cases of SEA in pregnancy and summarize the existing literature. Case 1: A 20year-old G1P0 presented at 35-week gestation with low back pain and lower extremity (LE) weakness. Magnetic resonance imaging (MRI) revealed thoracic SEA. The patient underwent cesarian delivery followed by posterior thoracic laminectomy and fusion (T9-11), abscess decompression, and antibiotic therapy. Unfortunately, there was a recurrence of her infection requiring a second irrigation and debridement 1 month after index procedure. At final follow-up, the patient had complete neurologic recovery. Case 2: A 38-year-old G10P0 presented at 36-week gestation in labor with LE weakness and difficulty ambulating. After delivery, she had significant LE neurologic deficits. MRI demonstrated thoracic osteodiscitis with associated epidural abscess. She underwent thoracic laminectomy and fusion (T7-12), abscess decompression, and antibiotic therapy. Unfortunately, despite aggressive treatment, she has persistent LE neurologic deficits. DISCUSSION: Pregnancy complicates the diagnosis and treatment strategies of SEA: back pain is very commonly underestimated, especially in the absence of fever and gross neurologic deficits. Prompt diagnosis and treatment are paramount to prevent neurologic decline and facilitate recovery. It is important to perform a focused physical exam noting motor strength, sensation, and reflexes. Coordinated management between the Emergency Department, OB-GYN, and spinal surgery team is required for best possible patient outcomes. Typically, management consists of aggressive surgical decompression and antibiotic therapy.

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Postoperative spinal cord infarction on a gravid woman with suspected IV drug use: a case report

Baldino

Recknagel

Beckham

2022

BMC Pregnancy Childbirth

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Background Back pain is common in the gravid population and spinal cord infarction (SCI) or chronic osteomyelitis are exceptionally rare underlying causes of back pain in this population. No case report to date has described this unexpected adverse event in a gravid woman with suspected history of IV drug use (IVDU). This diagnosis could potentially become more common with increasing rates of IVDU, and increased education could result in sooner recognition. Case A 38 year old G9P0171 at 24 weeks gestation with a complex past medical history, and a suspected history of IVDU, presented repeatedly with back pain. Following cesarean delivery at 36w2d, she developed signs and symptoms of an anterior spinal artery syndrome (ASAS) and had evidence of chronic osteomyelitis at T9-T10 on imaging. This required emergent decompressive laminectomy and ultimately resulted in paraplegia. Conclusion This case highlights the difficulties in recognizing all SCI risk factors pre-operatively and the importance of investigating back pain in pregnant patients with a suspected history of IVDU. We believe this patient’s chronic infection put her at an increased risk for SCI that was possibly compounded by the anatomical changes from its chronicity, possibly occurring in combination with several other precipitating causes of hypoperfusion. We hope this case report highlights the modern necessity to include a history, or suspected history, of IVDU as a red flag to initiate imaging in pregnant patients with acute, persistent, or unresolved back pain.

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Bacterial Spinal Epidural and Psoas Abscess in Pregnancy Associated with Intravenous Drug Use

Cited by 4 publications

References 18 publications

Psoas abscess in pregnancy: a review of the literature and suggestion of minimally invasive treatment options

Psoas abscess in pregnancy: a review of the literature and suggestion of minimally invasive treatment options

Spontaneous spinal epidural abscess in pregnancy: a case series

Postoperative spinal cord infarction on a gravid woman with suspected IV drug use: a case report

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