Infected Intraparenchymal Dermoids: An Underestimated Entity

Abstract

Infection secondary to a dermal sinus most commonly occurs in the form of cutaneous, epidural, or subdural abscesses. Rarely, it can result in an intramedullary abscess as a result of a dermal sinus. This study presents a clinicoradiological profile of 19 cases harboring abscesses within the dermoids and highlights the importance of dermal sinus acting as a pathway for infections to enter the nervous system. Emergent exploration, pus drainage, and minimal abscess wall excision along with prolonged antibiotic administration remained the management of choice in all cases. Methicillin-sensitive Staphylococcus aureus was the commonest offending organism. In all, 7 patients recovered to normal neurological status, 5 showed no improvement, and 7 improved partially. Improvement in motor power was noted, albeit partially, but bladder functions failed to recover even at long-term follow-up. Even when such infective complications of dermal sinuses are rare, these are potentially serious and disabling.

Management problems of intramedullary holocord abscess: an illustration in a pediatric case

“…Intense perilesional edema within the cord substance is noted as hyperintense signals on T2 scans. The rapid spread of cord edema, rather than the abscess itself, is the main culprit of causing fulminant neurological deterioration among these patients [3,5].…”

“…Of these, dermal sinus-associated intramedullary abscesses was the commonest cause [3], while one had intramedullary neoplasm-associated abscess and another developed abscess within a syrinx [4]. The present communication describes a unique case of primary intramedullary holocord abscess requiring multiple surgical interventions and drain placement for a successful outcome.…”

Dermal Sinus Tract of the Thoracic Spine Presenting with Intramedullary Abscess and Cranial Nerve Deficits

“…In case of intramedullary abscess, the patient can manifest relevant signs of infection or neurologic deterioration due to central nervous system inflammation or symptoms due to mass effect as it happened in the present case. It should be noted that intramedullary abscesses are rare but can sometimes extend to multiple levels [10,11]. …”

“…The pathogens most frequently involved with intramedullary abscess associated with dermal sinus are Staphylococcus species and Streptococcus species, and less frequently enterobacteria and anaerobes [5,6,10] . In the present case, the isolated pathogens (Corynebacterium species and Peptococcus species) had never been previously involved in intramedullary abscesses.…”

Spinal infections in children: A review

“…11 However, neonates can be affected as well (Table 2). [11][12][13][14][15][16] A number of risk factors exist for the acquisition of these infections, and are summarized in Table 3. Spinal infection in children Discitis Osteomyelitis Tubercular osteomyelitis Epidural abscess A B S T R A C T Spinal infections are uncommon but significant causes of morbidity and hospitalization in the paediatric population.…”