RESUMO
A 9-month-old healthy female presented during winter to the emergency department with a chief complaint of fever and prominent respiratory symptoms. She was discharged on oseltamivir with a presumptive diagnosis of influenza. She returned to the emergency department 2 days later with continued fever and more upper respiratory symptoms. She was admitted for intravenous hydration to the observation unit with a diagnosis of viral illness (with viral testing that returned positive for adenovirus) and dehydration. When her high fevers continued, bloodwork that was concerning for leukocytosis, elevated inflammatory markers, and elevated alkaline phosphatase was obtained. During her workup for fever, a full body magnetic resonance imaging was performed, which revealed the diagnosis of a C3 to L5 spinal epidural abscess. This case demonstrates the difficulty of making this important diagnosis in a preverbal child presenting with a concurrent virus during winter viral season.
Assuntos
Abscesso Epidural/diagnóstico por imagem , Imageamento por Ressonância Magnética , Infecções Estafilocócicas/diagnóstico por imagem , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Abscesso Epidural/tratamento farmacológico , Abscesso Epidural/microbiologia , Feminino , Humanos , Lactente , Oxacilina/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Imagem Corporal TotalRESUMO
We present a case of a patient with diabetes with a pleural empyema originated from a pyomyositis process established after a central line procedure. This empyema later on extended into the spinal canal deriving into an epidural empyema, leading towards a spinal neurogenic shock and death. We discuss the anatomical substrate for this extension as well as the anatomopathological findings observed in the autopsy.
Assuntos
Empiema Pleural/patologia , Abscesso Epidural/patologia , Canal Medular/patologia , Doenças da Medula Espinal/patologia , Infecções Estafilocócicas/patologia , Idoso , Autopsia , Complicações do Diabetes/microbiologia , Empiema Pleural/complicações , Empiema Pleural/microbiologia , Abscesso Epidural/etiologia , Abscesso Epidural/microbiologia , Evolução Fatal , Humanos , Masculino , Piomiosite/complicações , Piomiosite/diagnóstico , Canal Medular/microbiologia , Doenças da Medula Espinal/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificaçãoRESUMO
Staphylococcus lugdunensis is a coagulase-negative staphylococcus of growing importance and atypical behavior. The infections caused by this microorganism are becoming more frequent, having a broader spectrum. Psoas abscesses caused by this germ are rare, with few cases reported in the literature. In this work, we present a case of a psoas abscess caused by S. lugdunensis in a patient suffering from diabetes mellitus and rheumatoid arthritis, which was treated with intravenous cloxacillin with a good outcome.
Assuntos
Abscesso do Psoas/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus lugdunensis/isolamento & purificação , Antibacterianos/uso terapêutico , Artrite Reumatoide/complicações , Técnicas de Tipagem Bacteriana , Cloxacilina/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Abscesso Epidural/tratamento farmacológico , Abscesso Epidural/microbiologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Abscesso do Psoas/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus lugdunensis/patogenicidadeRESUMO
Nocardia species exist in the environment as a saprophyte; it is found worldwide in soil and decaying plant matter. They often infect patients with underlying immune compromise, pulmonary disease or history of trauma or surgery. The diagnosis of nocardiosis can be easily missed as it mimics many other granulomatous and neoplastic disease. We report a 69-year-old man who presented with chronic back pain and paraparesis. He was found to have Nocardial brasiliensis vertebral osteomyelitis and epidural abscess. Laminectomy and epidural wash out was performed but with no neurological recovery. This is the second reported case of N brasiliensis vertebral osteomyelitis in the literature.
Assuntos
Abscesso Epidural/microbiologia , Nocardiose/complicações , Osteomielite/microbiologia , Idoso , Antibacterianos/uso terapêutico , Abscesso Epidural/tratamento farmacológico , Abscesso Epidural/cirurgia , Humanos , Laminectomia , Masculino , Nocardiose/tratamento farmacológico , Nocardiose/cirurgia , Osteomielite/tratamento farmacológico , Osteomielite/cirurgia , Coluna VertebralRESUMO
An interesting case of pyogenic vertebral osteomyelitis with multiple epidural abscesses caused by non-pigmented Prevotella oralis is reported. The patient was a 68-year-old female who presented to the emergency room (ER) with severe pain and tenderness in her lower back with fever. She had recently undergone esophagogastroduodensoscopy (EGD) for complaints of esophageal reflux, which showed submucosal cyst in the esophagus. Magnetic resonance imaging (MRI) of the thoracic spine revealed multiple spinal epidural abscesses with signal enhancement at the level of T6 and T7, suggestive of vertebral osteomyelitis. Two blood cultures drawn one hour apart grew Prevotella oralis. The body fluid aspirated from the abscesses was also positive for the anaerobic commensal P. oralis. Necrosis associated with the submucosal cyst was implicated as the cause of sepsis and osteomyelitis due to this organism.
Assuntos
Idoso , Feminino , Humanos , Infecções por Bacteroidaceae/complicações , Abscesso Epidural/microbiologia , Osteomielite/microbiologia , Prevotella/isolamento & purificação , Doenças da Coluna Vertebral/microbiologia , Vértebras Torácicas , Infecções por Bacteroidaceae/diagnóstico , Abscesso Epidural/diagnóstico , Osteomielite/diagnóstico , Doenças da Coluna Vertebral/diagnósticoRESUMO
An interesting case of pyogenic vertebral osteomyelitis with multiple epidural abscesses caused by non-pigmented Prevotella oralis is reported. The patient was a 68-year-old female who presented to the emergency room (ER) with severe pain and tenderness in her lower back with fever. She had recently undergone esophagogastroduodensoscopy (EGD) for complaints of esophageal reflux, which showed submucosal cyst in the esophagus. Magnetic resonance imaging (MRI) of the thoracic spine revealed multiple spinal epidural abscesses with signal enhancement at the level of T6 and T7, suggestive of vertebral osteomyelitis. Two blood cultures drawn one hour apart grew Prevotella oralis. The body fluid aspirated from the abscesses was also positive for the anaerobic commensal P. oralis. Necrosis associated with the submucosal cyst was implicated as the cause of sepsis and osteomyelitis due to this organism.
Assuntos
Infecções por Bacteroidaceae/complicações , Abscesso Epidural/microbiologia , Osteomielite/microbiologia , Prevotella/isolamento & purificação , Doenças da Coluna Vertebral/microbiologia , Vértebras Torácicas , Idoso , Infecções por Bacteroidaceae/diagnóstico , Abscesso Epidural/diagnóstico , Feminino , Humanos , Osteomielite/diagnóstico , Doenças da Coluna Vertebral/diagnósticoRESUMO
Nocardia are a group of aerobic actinomycetes that are filamentous gram-positive, weakly acid-fast, and cause opportunistic infection in immunocompromised patients. Primary Nocardia infection mostly involves lung, skin and less commonly, the central nervous system (CNS). Among Nocardia CNS infections, spinal infection is extremely rare. We describe the first case of a spinal abscess caused by Nocardia nova in an immunocompetent patient who experienced a penetrating facial injury six months earlier. Nocardia species were isolated from intradural spinal abscesses and identified by 16S rRNA, hsp65 and secA1 sequence analyses. Surgical excision and treatment with amikacin, cefotaxime, and oral erythromycin was successful.
Assuntos
Abscesso Epidural/microbiologia , Imunocompetência , Nocardiose , Abscesso Epidural/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Nocardiose/diagnósticoRESUMO
Nocardia are a group of aerobic actinomycetes that are filamentous gram-positive, weakly acid-fast, and cause opportunistic infection in immunocompromised patients. Primary Nocardia infection mostly involves lung, skin and less commonly, the central nervous system (CNS). Among Nocardia CNS infections, spinal infection is extremely rare. We describe the first case of a spinal abscess caused by Nocardia nova in an immunocompetent patient who experienced a penetrating facial injury six months earlier. Nocardia species were isolated from intradural spinal abscesses and identified by 16S rRNA, hsp65 and secA1 sequence analyses. Surgical excision and treatment with amikacin, cefotaxime, and oral erythromycin was successful.