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Case Reports
. 2024 Apr 8;85(2):e29-e38.
doi: 10.1055/a-2267-1810. eCollection 2024 Apr.

Acute Paraplegia Caused by Spinal Epidural Empyema Following Infectious Cellulitis of the Hand: Case Report and Literature Review

Breno Nery  1 , Cláudio Brandão Filho  1   2 , Lucas Nunes  1 , Eduardo Quaggio  1 , Fred Bernardes Filho  1 , Joaquim Alencar Neto  1 , Layssa Rhossana Melo  1 , Anna Carolyne Oliveira  1 , Rafael Rabello  1 , Victoria Rodrigues Durand  1 , Rayssa Rocha Silva  1 , Rafael Emmanuel Costa  1 , José Alencar Segundo  1
Affiliations
Case Reports

Acute Paraplegia Caused by Spinal Epidural Empyema Following Infectious Cellulitis of the Hand: Case Report and Literature Review

Breno Nery et al. J Neurol Surg Rep. .

Abstract

Background Spinal epidural abscess is a rare but serious condition that can cause spinal cord compression and neurological deficits. Case Description and Methods The article reports a case of a 31-year-old patient who presented with an infectious cellulitis in the left hand, which progressed to a spinal epidural abscess. The diagnosis was confirmed by clinical examination and magnetic resonance imaging. Treatment involved laminectomy, after which the patient had complete recovery of neurological deficits. This article is a case report with a literature review. Patient data and images were collected by the researchers who participated in the patient's care. The literature was reviewed by one of the researchers based on the search for articles in the PubMed database. For the research, the following keywords were inserted: "Spinal epidural empyema," "Spinal epidural abscess." Conclusion Spinal epidural abscess is often underdiagnosed, which can lead to delays in treatment and serious complications. The relationship between cellulitis and spinal epidural abscess may be related to the spread of infection through the lymphatic or blood system.

Keywords: case report; infectious cellulitis; paraplegia; review; spinal epidural abscess.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Left dorsal hand is erythematous, swollen, and tender. Dorsal metacarpal vein (circle) was the local of vein puncture for administration of amiodarone.
Fig. 2
Fig. 2
A thoracic spine T2-weighted axial MRI showing a fluid collection with hypersignal in the epidural space (arrowhead), displacing the spinal cord anteriorly, and also other discrete fluid collections with hypersignal on the intrathoracic paravertebral (red arrow) and extra-thoracic paraspinal (yellow arrow) areas. MRI, magnetic resonance imaging.
Fig. 3
Fig. 3
A thoracic spine T1-weighted sagittal MRI with fat saturation, obtained after the intravenous application of a Gd-containing contrast agent, shows intense marginal contrast enhancement of the epidural fluid collection in the vertebral canal (arrowhead). MRI, magnetic resonance imaging.
Fig. 4
Fig. 4
Schematic representation of the posterior view of the spinal column, indicating a purulent collection in the epidural space between T4 and T8 vertebrae, which is characteristic of spinal epidural abscess in this location.
Fig. 5
Fig. 5
Schematic drawing showing the route taken by the infectious process.
Fig. 6
Fig. 6
Sagittal T2-weighted magnetic resonance image showing the patient's spinal column after laminectomy and antibiotic treatment. No further evidence of SEA is detected, indicating successful treatment. SEA, spinal epidural abscess.
See this image and copyright information in PMC

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References

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