Spinal epidural abscess treated with antibiotics alone

Abstract

SUMMARYSpinal epidural abscess (SEA) is a rare clinical condition among children. Most patients do not present with classical signs. A 13-year-old boy without any predisposing factors presented with paraparesis, bladder and bowel involvement. MRI spine demonstrated an SEA at the C7 and D1 levels on both sides of the midline with cord oedema at the C2-3 to C6 level with minimal marrow oedema in the C6 vertebral body. We treated the patient with antibiotics (ceftriaxone and vancomycin) alone. The patient showed excellent response with only minimal residual gait disturbance at the end of 6 weeks of antibiotic therapy. This is the first paediatric report of complete recovery of a patient at clinical stage 4 following antibiotic treatment alone from India. However, caution should be exercised to closely monitor the patient's recovery as any progression in the neurological state warrants surgery. BACKGROUND

Beware: Opisthotonic posturing and epidural disease

“…All nine received 4–6 weeks of intravenous therapy, and all recovered without significant sequelae. Although some studies have described the successful use of antibiotic therapy alone in select patients, a combined surgical decompression and extended intravenous antibiotic therapy approach remains standard for paediatric patients' treatment …”

Thoracic spinal epidural abscess caused by fishbone perforation

“…It was reported that several causative organisms may cause SEA, including Staphylococcus aureus , Gram-negative bacteria, coagulase-negative bacteria, staphylococcus, Escherichia coli , Pseudomonas aeruginosa , streptococcus species, and Mycobacterium spp. [2,20,21] Among them, S. aureus is the leading agent. [22] Notably, the sensitivity of blood cultural test may decline with pre-use of antibiotics.…”

“…[21] MRI is crucial to establish the diagnosis and monitor the disease progression. [20,24] Especially, gadolinium-enhanced MRI is the most sensitive imaging method, [22] which should be taken as soon as SEA is suspected. [19] Relatively, CT scan is less specific and cannot distinguish SEA from other lesions that compress the thecal sac.…”

Back pain in a young adult

“…14 15 Spinal abscesses have been treated successfully with antibiotics alone or with image guided aspiration of the collection, although deterioration can be rapid and irreversible. 16 Some studies report a worse overall motor outcome in those treated conservatively, 14 except for spinal cord compression secondary to tuberculosis, which usually responds well to treatment with steroids and antibiotics. Severely debilitated patients might not be suitable for surgery if they are not fit for general anaesthesia.…”