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Results for “Epidural Abscess”

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PubMed1999

Spinal epidural abscess associated with epidural catheterization: report of a case and a review of the literature.

We describe a 53-year-old man who developed a catheter-related epidural abscess 8 days after left upper lobectomy for lung cancer. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in a culture of the epidural pus. Magnetic resonance imaging was essential for the diagnosis of epidural abscess and for determining the extent of spread. The patient was treated by laminectomy and administration of appropriate antibiotics, with almost complete recovery, except for urinary retention. A literature search yielded 29 additional cases of catheter-related epidural abscess. The median duration of catheterization was 4 days and the median time to onset of the clinical symptoms after catheter placement was 8 days. Eleven of the 30 patients had some underlying disorders, including malignancy or herpes zoster, or were receiving steroids. Nine of the 10 patients with thoracic epidural abscess had persistent neurological deficits, whereas 12 of the 15 patients with lumbar epidural abscess showed a full recovery after treatment. Surgical decompression was not required in six patients without significant neurological deficits, who recovered following antibiotic treatment (four patients) or percutaneous drainage (two patients). Thoracic catheters are associated with a disproportionately high incidence of epidural abscess and persistent neurological sequelae following treatment.

Abscess↗
PubMed1998

Epidural abscess after epidural analgesia treated successfully with antibiotics.

Spinal extradural abscess is an infrequent, but serious complication to extradural catheters. Early diagnosis is essential for successful treatment. An extradural abscess may develop slowly over days to several weeks and symptoms may be vague and unspecific, delaying correct diagnosis. Meticulous supervision of the patients is required and must continue as long as an epidural catheter is in place and for some time after the catheter has been withdrawn. This case report describes a patient undergoing extensive reconstructive plastic surgery after a leg trauma. For postoperative pain treatment a continuous epidural infusion of bupivacaine was given. After 10-14 days an extradural abscess developed with increasing low back pain but without any neurologic symptoms. With antibiotics a complete resolution of the extradural abscess occurred, documented by computerized tomography (CT).

Abscess↗
PubMed2003

[Iliopsoas abscess accompanied by epidural abscess--a case report].

A 55-year-old man was admitted to a hospital with pain of the low back as well as the left leg, and fever. He was suspected of suffering from the lumbar disc herniation because of the presence of Lasegue's sign on the first physical examination. Abdominal computed tomography, however, revealed the swelling of the left iliopsoas muscle. Iliopsoas abscess accompanied epidural abscess was confirmed by subsequent magnetic resonance imaging (MRI). Antibiotic therapy was started for the successive 8 days. The fever resolved, but the pain persisted. The abscess extending from the iliopsoas muscle to the epidural space was still seen on the MRI 20 days after the completion of the antibiotic therapy, and he still complained of the pain of his low back and left leg. Therefore, we conducted epidural puncture under fluoroscopic guidance. Approximately 3 ml of pus was aspirated from the epidural space. Then, his complains decreased remarkably. Iliopsoas abscess should be taken into account in case of a patient with pain on the low back and leg and also inflammatory signs such as fever and leucocytosis.

Anti-Bacterial Agents↗
PubMed2000

[Epidural abscess following repeated epidural catheter placement for delivery].

This case report describes an epidural abscess with pseudomonas aeruginosa after the placement of two epidural catheters within one hour in a healthy 29-year old primipara. Spontaneous delivery occurred after an episiotomy about 4 hours later. Afterwards the epidural catheter was removed completely and again 5 hours later the woman was discharged from the hospital. On postpartal day 3 the patient experienced lumbar back pain, slight weakness of both legs and some difficulties to urinate. On day 14 after delivery magnetic resonance imaging revealed an epidural abscess at the height of the 4th and 5th lumbar vertebrae. Immediately a neurosurgical debridement and drainage was performed. The patient was discharged at home on the 10th postoperative day without neurological sequelae. In this case report a hematogenic infection was considered. The traumatized tissue from the two catheter placements within one hour could easily be colonized with pseudomonas aeruginosa originating from a transient bacteriemia due to an episiotomy inspite of adequate local disinfection measures. The case report also underlines the need for proper information of the patient about the possibilities of complications after epidural anesthesia in outside patients.

Abscess↗
PubMed1996

Spinal epidural abscess associated with epidural anesthesia: gadolinium-enhanced magnetic resonance imaging and its usefulness in diagnosis and treatment.

A case of spinal epidural abscess following epidural anesthesia is described. Gadolinium-enhanced magnetic resonance images were essential in diagnosis of the abscess without frank pus formation, in defining the extension of the infection, and in assessing the therapeutic effect. The patient was successfully treated non-operatively before neurological symptoms developed and full recovery was achieved.

Abscess↗
PubMedDate not supplied

A case of Nocardia epidural abscess.

Spinal epidural abscess due to nocardia is extremely rare. We report a patient who presented to our Emergency Department with a complaint of low back pain and fever, who was later found to have a spinal epidural abscess. Tissue cultures from the abscess grew nocardia asteroides. Magnetic resonance imaging scan is the imaging study of choice for diagnosing spinal epidural abscess. Treatment for nocardia spinal epidural abscess involves a combination of surgical debridement and prolonged sulfonamide administration.

Abscess↗
PubMed2005

[A case of acute cervical epidural abscess].

Spinal epidural abscess (SEA) is a rare condition with potentially devastating consequences and more aggressive diseases than previously recognized. We report a case with cervical epidural abscess treated successfully by emergent neural decompression. A 49-year-old man presented with fever and cervical pain. An magnetic resonance imaging (MRI) showed an epidural abscess at C5-6. His condition deteriorated with the development of complete sensory loss and tetraparesis. Emergent anterior neural decompression was performed, and pus was aspirated which grew Staphylococcus aureus. Adequate antibiotics were administered, and the patient showed remarkable improvement of neurological signs and symptoms. He underwent reconstruction surgery 3 weeks after the first operation, and returned to his original job 3 months after the operation. Prompt diagnosis and satisfactory surgical decompression are essential to avoid irreversible neurological sequelae in epidural abscess of the cervical spine.

Acute Disease↗
PubMed2004

Epidural abscess and meningitis after epidural corticosteroid injection.

Epidural abscess with and without associated meningitis after epidural corticosteroid injections for radicular back pain is a rarely reported complication. We report the occurrence of an epidural abscess and meningitis in a 70-year-old man after 2 epidural corticosteroid injections for treatment of acute radicular lumbar back pain. At the time of diagnosis, cerebrospinal fluid cultures grew Staphylococcus aureus, and the patient was treated with intravenous antibiotics. Possible predisposing factors for the development of an epidural abscess and meningitis in this patient include a 2-year history of neutropenia and an accidental dural puncture that occurred during performance of the first epidural injection. A literature search identified 11 reported cases of epidural abscess, 2 of epidural abscess and meningitis, and 1 of meningitis attributed to epidural corticosteroid injections. Eight of the 14 reported patients were immunocompromised, and 8 (67%) of the 12 in whom cultures of blood, cerebrospinal fluid, or epidural pus were performed had results positive for S. aureus. Antibiotic prophylaxis for S. aureus should be considered for immunocompromised patients undergoing epidural corticosteroid injections.

Adult↗
PubMed2002

[A case of spinal epidural abscess associated with retropharyngeal abscess].

Spinal epidural abscesses are known to occur associated with retropharyngeal abscess, but such cases are few in the literature. We treated a 72-year-old woman who reported pain in the back of the neck. Computed tomography (CT) showed a retropharyngeal abscess extending to the upper neck through the carotid space on the left side and an magnetic resonance imaging (MRI) showed a spinal epidural abscess without cervical vertebral osteomyelitis. The abscess was assumed to reach the epidural space along the nerve root through the intervertebral foramen. Since tonsillitis appeared to cause the retropharyngeal abscess, we performed tonsillectomy, and then drained pus through the superior constrictor muscle, effecting a subsequent cure. Staphylococcus aureus was recovered from both the pus and tonsil, and Streptococcus constellatus, a member of the Streptococcus milleri group, from the tonsil. Based on a review of the literature, clinical courses of spinal epidural abscess associated with retropharyngeal abscess are not always simple, as 4 of the 7 cases found demonstrated poor prognosis. Spinal epidural abscess should be considered a critical complication of retropharyngeal abscess.

Aged↗
PubMed1999

[Epidural abscess associated with epidural block in a patient with immunosuppressive disease].

A patient with myeloproliferative disorders and diabetes mellitus received epidural block twice for treatment of the low back and leg pain. The drugs used were 1% mepivacaine 4 ml for the first and 1% mepivacaine 6 ml and dexamethazone 4 mg for the second on the next day. Epidural abscess was noticed 2 days later when pus was aspirated through a block needle. MRI revealed the abscess localized at L5/S1. Intensive treatment including epidural drainage and antibiotics succeeded in healing the abscess. Use of epidural block for immunocompromized patients should be decided carefully.

Abscess↗
PubMed1999

Spinal epidural abscess complicating chronic epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging.

We reviewed the records of all patients who had received an epidural catheter for management of chronic cancer pain in a 3-year period (1993-1996). Patients with nervous system infections were identified, and pertinent clinical, radiological (magnetic resonance imaging), and bacteriological data were analyzed. We identified 11 patients who developed spinal epidural abscess (SEA). All of these had back pain; radicular signs occurred in seven patients and spinal cord compression in two patients. Magnetic resonance imaging revealed SEA in all 11 patients. SEA was iso- to hypointense on T1-weighted images and hyperintense on T2-weighted images relative to spinal cord. After gadolinium administration seven lesions showed characteristic rim enhancement while three showed minimal enhancement. No signs of diskitis or osteomyelitis were present, and the abscess was always localized to the posterior epidural space. Cultures were positive in all cases and revealed Staphylococcus epidermidis in eight and S. aureus in three. All patients were treated with intravenous antibiotics, and four had an additional decompressive laminectomy. Two patients died within 1 week of diagnosis from overwhelming septicemia despite apparently adequate antibiotic treatment. Within 4 weeks after diagnosis of SEA two patients died from widely metastatic disease, although infection may have contributed. One patient developed septicemia while receiving appropriate antibiotics and underwent emergency laminectomy. The neurological deficits recovered in all patients who survived the acute infectious episode. We conclude that patients with chronic epidural catheters for cancer pain require prompt neurological evaluation and magnetic resonance imaging when SEA is suspected. Early evaluation and treatment may lead to full recovery.

Adult↗
PubMed2006

Abdominal pain from a thoracic epidural abscess.

Spinal epidural abscesses are difficult to diagnose and are associated with high morbidity and mortality. A 61-year-old Chinese woman fell and was admitted 5 days later with constant epigastric pain and constipation. Clinical examination was initially normal. Five days after admission, she developed urinary retention and mild lower limb weakness, progressing overnight to paraplegia. Clinical examination was consistent with a thoracic myelopathy. Neuroimaging showed a paracentral fluid collection compressing the thoracic cord at T8 level. Emergent neurosurgical intervention revealed an epidural abscess, which was drained. She responded to a 9-week course of antibiotics and recovered fully. Radicular pain from thoracic pathology can mimic intraabdominal pathology, and a high index of suspicion and prompt surgical intervention are essential to avoid the potentially devastating consequences of delayed recognition of epidural abscesses.

Abdominal Pain↗