Spinal intramedullar cord abscess which developed as a result of congenital spinal dermal sinus

Abstract

Dermal sinus is a type of spina bifida occulta which develops as a result of incomplete separation of the cutaneous ectoderm from the underlying neural ectoderm. It generally has sacral location and may be accompanied by colour change, increased hairiness and sacral dimple. In half of cases the sinus may be associated with the spinal canal. Dermal sinus infection as a result of this may cause dramatic outcomes such as paraplegia and myelitis. The case is here presented of an 18-month old female infant who had started a fever 40 days previously, was taken to a doctor and treatment of antibiotics and antipyretics was started for a diagnosis of pharyngitis but the high fever continued despite the treatment. After 20 days, redness and swelling on the back was noticed together with the fever and as there was a yellow-coloured discharge from the area of the swelling, the doctor was again consulted and the antibiotics were changed. The patient was then brought to our clinic, as in the previous 3 days, there had been increasingly reduced movement of the feet. As a result of tests applied to the patient, intramedullary abscess was determined. In neonates and infants, the spinal area must be evaluated well. It must be kept in mind that in patients with colour change, increased hair and especially sacral dimple, there could be midline closure defects. Pam Med J 2017;10(2):188-191Key words: Dermal sinus, Sacral dimple, Abscess, Early diagnosis. ÖzetDermal sinus, spina bifida occultanin bir tipi olup kütanöz ektoderm ile altinda bulunan nöral ektodermin ayrilmasinin tamamlanamamasi sonucu gelişir.Genellikle sakral yerleşimlidir ve ciltte renk değişikliği, killanma artişi,sakral gamze eşlik edebilir. Olgularin yarisinda sinüs spinal kanal ile ilişkili olabilir. Bunun sonucu olarak dermal sinüs enfeksiyonu, parepleji, myelit gibi dramatik sonuçlara neden olabilir. Bir buçuk yaşinda kiz hasta 40 gün öncesinde ateşi başlamiş ve başvurduğu doktor tarafindan farenjit tanisiyla antibiyotik ve ateş düşürücü tedavisi başlanmiş ancak tedaviye rağmen ateş yüksekliği devam etmiş. Yirmi gün önce ateş yüksekliği ile birlikte sirtinda kizariklik ve şişlik fark edilmiş ve şişlik yerinden sari renkli akinti gelmesi üzerine tekrar başvurduğu doktor tarafindan antibiyotiği değiştirilmiş. Son üç gündür giderek artan ayak hareketlerinde azalma nedeniyle kliniğimize başvuran ve yapilan tetkikler sonucu intramedüller apse tespit edilen hasta sunuldu. Yenidoğan dönemindeki hastalarda spinal bölge iyi değerlendirilmeli, renk değişikliği, killanma artişi ve özellikle sakral gamzesi olan hastalarda orta hat kapanma defektleri olabileceği akilda tutulmalidir. Derg 2017;(2):188-191 Pam Tıp