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ACUTE SPINAL CORD SYNDROME SECONDARY TO MEDULLARY EPIDURAL EMPYEMA: CASE REPORT
Apresentação do caso
Introduction: Epidural empyema has a prevalence of 1 in 20,000 hospital admissions, being an uncommon infectious entity. The reported case addresses the clinical evolution of an adolescent with acute medullary signs secondary to medullary epidural empyema compression as a complication of acute meningitis. Case presentation: JGR, 13 years old, previously healthy, was admitted to the emergency service complaining of changes in lower limb movements, urinary retention and headache that started 5 days ago, hyaline coryza, hyperthermia (not measured) for 7 days and no history of previous trauma. On physical examination, he presented flaccid and symmetrical paresis and absence of osteotendinous reflexes in the lower limbs, and presence of kerning and brudzinski meningeal signs. Contrast-enhanced cranial tomography showed no signs of intracranial hypertension and liqueur puncture showed infectious signs and isolation of Streptococcus pneumoniae in culture. However, in the MRI findings of the spinal cord, epidural empyema with compression at the lumbosacral level and cauda equina was identified. Treatment was initiated according to antibiogram with progressive remission of signs and symptoms in 15 days. The unusual aspect in this case is related to the rapid evolution to epidural empyema in a young and previously healthy patient.
Discussion: Medullary epidural empyemas are usually related to bacteremia or direct extension of a nearby infectious focus, but rarely result from complications of acute meningitis or lumbar puncture, as they are manifested by a painful and febrile medullary syndrome, usually subacute. The diagnosis is made through imaging and the gold standard treatment is based on prolonged antibiotic therapy and surgical drainage in the indicated cases.
Final comments: Therefore, it is concluded that epidural empyema should be considered in cases of bacterial meningitis, since it proves to be a diagnostic and therapeutic challenge, given its nonspecific clinical and laboratory signs and, even though it is a rare complication, it should be investigated in patients with acute spinal cord syndrome and infectious signs.
Referências (se houver)
Keywords: Medullary epidural empyema; acute spinal cord syndrome; acute bacterial meningitis; child neurology
Fonte de Fomento (se houver)
Declaração de conflito de interesses de TODOS os autores
no conflict of interest
universidade do estado de Sao Paulo - UNESP - São Paulo - Brasil
Maria Beatriz Bravin, Gabriela de Castro Fim, Lucas Barbosa Napolitano de Moraes, Lara Cristina Antunes dos Santos, Augusto Ventura Ceranto, Bruna Eugenia Gomes Felipe, Lethícia Nogueira Santos Barreto, Heloisa Carolina Massucato Bravin, Mirelle Tristao de Souza