Iatrogenic epidural spinal abscess.

E Bollensen; S Menck; J Buzanoski; H W Prange

doi:10.1007/bf00190318

Home/Archive/PubMed

PubMed · 8305833

Iatrogenic epidural spinal abscess.

E Bollensen·S Menck·J Buzanoski·H W Prange

View original source ↗Export metadata ↓

Abstract

We present four cases of iatrogenic epidural spinal abscess directly caused by externally introduced catheters or probes. In two patients the infection spread per continuum, in the other two patients due to haematogenous dissemination. Clinical presentation in each case included generalized malaise with fever, signs of meningeal inflammation and focal neurological signs at the spinal level. The diagnosis was made on the basis of inflammatory changes in the cerebral spinal fluid and localization of the abscess by means of computer and magnetic resonance tomography. A broad-spectrum antibiotic regimen included a penicillinase-resistant preparation because of the frequent involvement of Staphylococcus aureus. It is our experience that a good outcome is dependent on early and specific treatment.

Explore related subjects

Abscess Aged Aged, 80 and over Catheterization Epidural Space Female Humans Iatrogenic Disease Magnetic Resonance Imaging Male Middle Aged Spinal Cord Diseases Tomography, X-Ray Computed Case Reports Journal Article

Keep this discovery

Explore connections, maps & timelines

BibTeX RIS

E Bollensen, S Menck, J Buzanoski, H W Prange. 1993. Iatrogenic epidural spinal abscess.. https://doi.org/10.1007/bf00190318

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

Intrarenal abscesses due to Ureaplasma urealyticum in a transplanted kidney.

A young woman developed multiple abscesses in her transplanted kidney. Amplification of the 16S rRNA gene with subsequent sequencing revealed Ureaplasma urealyticum as the infectious agent. Microbiological diagnosis and sensitivity testing led to therapy with levofloxacin, resulting in rapid recovery of the patient.

Abscess↗

PubMed2007

Intramedullary spinal cord abscess complicating thoracic spondylodiscitis caused by Bacteroides fragilis.

Intramedullary spinal cord abscess associated with infectious spondylodiscitis is a rare entity. The case of a 66-year-old man with an intramedullary spinal cord abscess complicating thoracic spondylodiscitis is presented. The patient was unable to ambulate independently due to weakness of the legs. MR imaging showed findings suggestive of infectious spondylodiscitis at the T5-T6 level associated with epidural and intramedullary spinal cord abscesses. Biopsy of the intervertebral disc was performed and Bacteroides fragilis was isolated. Antibiotic therapy was instituted, and MR imaging of the thoracic spine was performed 6 weeks after the initiation of treatment, showing resolution of the epidural and intramedullary spinal cord abscesses.

Abscess↗

PubMed2007

Parapharyngeal abscess in a patient receiving etanercept.

OBJECTIVE: To report a case of parapharyngeal abscess associated with Streptococcus viridans in a patient with rheumatoid arthritis receiving treatment with etanercept. CASE SUMMARY: A 40-year-old man diagnosed with rheumatoid arthritis had received treatment with nonsteroidal antiinflammatory drugs, methotrexate, and deflazacort. Six months prior to admission, the patient had a Disease Activity Score of 3.4; clinicians decided to start treatment with etanercept. Chest X-rays were normal and the tuberculin skin test was negative. Treatment with etanercept plus methotrexate was started. Three months later, methotrexate was discontinued. Six months after etanercept therapy was started, the patient presented to our emergency department with a swelling of his neck, odynophagia, otalgia, and trismus. The clinical course was consistent with parapharyngeal abscess. Etanercept treatment was suspended. The parapharyngeal abscess was drained and intravenous methylprednisolone, amoxicillin/clavulanic acid, and clindamycin were administered. The parapharyngeal abscess secretion culture was positive for S. viridans and Bacteroides spp. The patient's condition improved with antibiotic therapy; he was discharged 5 days after admission. DISCUSSION: Tumor necrosis factor-alpha plays an essential role in the immune-mediated response to infection. In our patient, the most possible cause of parapharyngeal abscess was considered to be etanercept because of the temporal relationship between exposure to the drug and onset of symptoms. Etanercept was the only drug administered before the abscess developed. Based on the Naranjo probability scale, an association between etanercept and the adverse reaction could be considered possible. CONCLUSIONS: Patients initiated on etanercept therapy should be closely monitored for the development of tuberculosis and other infections. During treatment, all febrile or novel illnesses should be evaluated promptly. If clinical evaluation leads to the suspicion of tuberculosis and other infections associated with etanercept, it should be discontinued immediately.

Abscess↗