Spinal epidural abscess with myelitis and meningitis caused by Streptococcus pneumoniae in a young child

Abstract

Background: Spinal epidural abscess (SEA) in children is a rare infectious emergency warranting prompt intervention. Predisposing factors include immunosuppression, spinal procedures, and local site infections such as vertebral osteomyelitis and paraspinal abscess. Staphylococcus aureus is the most common isolate.

Design: Case report and literature review.

Findings: A 2.5-year-old boy with tetraparesis was found to have an SEA in the posterior lumbar epidural space with evidence of meningitis and myelitis on MRI spine in the absence of any local or systemic predisposing factors or spinal procedures. Streptococcus pneumoniae was isolated from the evacuated pus.

Conclusions: Definitive treatment of SEA is a combination of surgical decompression and iv antibiotics. Timely management limits the extent of neurological deficit.

Figure 1

Sagittal sections of the spine reveals lower lumbar epidural collection measuring 1.2 × 2.3 × 3 cm³ appearing hypointense on T1- and hyperintense on T2-weighted images with mild post-contrast peripheral enhancement.

Figure 2

Altered signal intensity involving the entire cord with cord expansion on T2-weighted sagittal sections suggestive of myelitis.

Figure 3

Post-contrast sections at the L4 level showing shaggy enhancement of the cauda equina and leptomeningeal enhancement.