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Case Reports
. 2021 May 8:6:100067.
doi: 10.1016/j.xnsj.2021.100067. eCollection 2021 Jun.

Pediatric Group A streptococcal spinal epidural abscess presenting with recurrent symptoms of viral illness: An operative case report

Khushdeep S Vig  1 , Matthew Amarante  1 , Ian Hutchinson  1 , James Patrick Lawrence  1
Affiliations
Case Reports

Pediatric Group A streptococcal spinal epidural abscess presenting with recurrent symptoms of viral illness: An operative case report

Khushdeep S Vig et al. N Am Spine Soc J. .

Abstract

Background: Spinal epidural abscess (SEA) in children is a rare condition with dangerous sequelae, and with only 22 other cases reported in the literature, treatment algorithms are poorly understood. Quick identification of the classic tried of sepsis, back pain and neurological deficit is critical. Source identification difficult and often cannot be identified. Reported pathogens include varicella-zoster virus, S. aureus, and S pyogenes.

Case description: We report a case of spontaneous pediatric SEA in a 22-month old female without obvious neurologic deficit, who underwent a T10-11 decompressive laminotomy and evacuation of abscess and subsequent 3-week course of intravenous ceftriaxone for culture positive S. pyogenes.

Outcome: The patient showed marked improvement in symptoms after decompression. 5 weeks postoperatively after transitioning from intravenous ceftriaxone to oral ceftin, the patient redeveloped a deep space infection and was taken back for a repeat debridement. The cultures from this procedure were negative and the patient was discharged on oral clindamycin.

Conclusions: Pediatric spontaneous SEA is a rare condition and early diagnosis and surgical intervention if indicated can prevent dangerous sequelae. Further studies into the surgical indications for decompression will aid in algorithmic decision making.

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Conflict of interest statement

None.

Figures

Fig 1
Fig. 1
T2 STIR MRI sequence with gadolinium enhanced contrast depicting a loculated epidural collection extending from T5-T11 with significant dilatation of the central spinal canal extending from T3-T11 without evidence of discitis or osteomyelitis.
Fig 2
Fig. 2
T2 STIR MRI sequence with gadolinium enhanced contrast depicting a loculated epidural collection extending from T5-T11 with significant prominence around T9-10 on the ventral and left side of the thecal sac, causing rightward displacement of the spinal elements. Incidentally, there was evidence of a contrast-enhancing fluid collection in the dependent portion of the left pleural cavity.
Fig 3
Fig. 3
Timeline illustration depicting the patient's clinical course.
See this image and copyright information in PMC

References

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