Spinal intradural abscess caused by hematogenous spread of Prevotella oralis in a 3-year-old child with an asymptomatic congenital spinal abnormality

Abstract

Method: We report a 3-year-old child with progressive paraparesis who was diagnosed with an intradural spinal abscess, epidermoid cyst and dermal sinus. The patient was treated surgically followed by antimicrobial treatment. Result: Intraoperative abscess culture was positive for Prevotella oralis, which has not been reported before as a single isolate in literature. The patient's neurologic status was significantly improved after surgical treatment. Conclusion: Prophylactic antimicrobial therapies should cover the anaerobic bacteria in spinal intradural abscess. Surgical decompression with laminectomy and duraplasty may be warranted to achieve immediate neurologic improvement in such cases.

Surgical Outcome of Spinal Subdural Abscesses: A Report of Four Consecutive Patients and Brief Review of the Literature

“…12 We compared our cases with case series and case reports in the literature (►Table 5). 1,8-11, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] In 1917, Elsberg was the first to operate on a spastic paraplegic patient with an SSA. Ten years later, Sittig treated another patient.…”

“…26,30 30 In patients with minor symptoms, the treatment strategy should be tailored individually. 1,[8][9][10][11][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Based on our experience, laminoplasty is very useful for avoiding posterior instrumentation. 4,6,7 Because we treated our cases urgently, we could not perform intraoperative electrophysiologic monitoring.…”

“…26,33 In DWI, most pyogenic abscesses are hyperintense signals, indicating restricted water diffusion related to high viscosity of inflammatory cells in pus. 21,24,26,33 This study has some limitations. First, it is a retrospective study that may be influenced by inherent biases.…”

Pediatric Spinal Subdural Abscesses: A Report of Three Consecutive Patients

“…Reported etiological causes of SSA are hematogenous dissemination, iatrogenic contamination such as steroid injection, lumbar puncture, or previous spinal surgeries, and local extension [21-25]. In the literature, several studies have reported predisposing factors such as congenital dermal sinus [8, 10, 11, 13, 15], dermoid cysts [13, 15-17], anatomical abnormalities of the spinal cord [18], diabetes mellitus [23], drug abuse, immunodeficiency syndromes, immunosuppressive situations, and repetitive meningitis [8]. In children, intradural extra- and intramedullary infections are more commonly caused by pre-existing congenital abnormalities in the spinal column [3, 8, 10, 11, 22-24].…”

A case report of a 4-year-old boy with intradural spinal cord abscess successfully treated with adjuvant hyperbaric oxygen therapy

“…Spinal intradural abscess is an extremely rare condition, especially in pediatric cases (4). Iatrogenic spinal infections (ISE) are considered possible complications that could arise after spinal surgical procedures (3,9).…”