Spinal Epidural Abscess (SEA) is uncommon and rare condition in immunocompetent population and even more rare in pediatric group. The incidence of spinal epidural abscess appears to be increasing and comprises up to 2 per 10,000 hospital admissions. The presentation is variable and diagnosis can be easily missed on first visit. The diagnosis is established by history, clinical examination finding, increased inflammatory markers and neurological imaging. Surgical decompression and drainage in combination with antibiotic for four to six weeks are the typical treatment for SEA. An alternative treatment with parenteral antibiotic only is an alternative treatment. We reported an 11-year-old girl presented fever, chest and back pain she was found to have unsteady gait and lower extremity weakness. Spinal MRI showed heterogeneous enhancing collection in the posterior epidural space from the level of T2 vertebra to T10 vertebra. She was treated with antibiotic for 6 weeks without complications.
Abscess; Epidural; Immunocompetent; Pediatric; Spine
Cases |
Gender, Age |
Spine Level |
Presentation |
Primary Diagnosis |
CSF |
Positive Blood Culture |
Etiology |
Fotaki [48] |
M, 2.5 y |
C3-T2 |
Fever, neck pain and stiffness |
Meningitis |
Pleocytosis, low glucose, elevated protein |
Yes |
Group A Streptococcus |
Horner [49] |
M, 34 d |
C3-C5 |
Fever, irritability, decreased oral intake |
Meningitis |
Pleocytosis (WBCs 2113/mm3) Low glucose, elevated protein |
Yes |
Methicillin-sensitive Staphylococcus aureus |
Paro-panjan [50] |
M, 3 wk |
C4-C5 |
Irritability, paresis and areflexia of both arms. |
- |
Pleocytosis |
No |
Group A Streptococcus |
Aycan [8] |
F, 13 y |
T12-L5 |
Fever, back pain, paraparesis, |
- |
Not performed |
Not available |
Methicillin- resistant Staphylococcus aureus |
Vergori [2] |
M, 15 y |
T11-L2 |
Fever, headache and back pain in lumbar-sacral region, bilateral leg weakness |
Meningitis |
Pleocytosis, glucose normal, protein elevated |
No |
Methicillin-sensitive Staphylococcus aureus |
Harris [3] |
M, 21 m |
L4-L5 |
Fever, refuse to walk |
Septic arthritis |
Not performed |
No |
Group A beta-hemolytic Streptococcus |
Hawkins [4] |
F, 17 y |
L1-L4 |
Fever, nausea, vomiting |
- |
Not performed |
No |
Unknown |
Hawkins [4] |
M, 3y |
T1-L2 |
Fever, stomachache |
- |
Not performed |
Yes |
Methicillin- resistant Staphylococcus aureus |
Hawkins [4] |
M, 1.2 y |
L3-L4 |
Refusal to walk, irritability, weakness |
- |
Not performed |
No |
Unknown |
Pathak [51] |
M, 13 y |
C7-T1 |
Transient fever, neck and upper back pain, tingling sensation in hands and feet, urine incontinence, abdominal distension, inability to sit and walk |
Acute myelitis, diskitis, meningitis |
800 cells/mmc, 2% PMN, glucose 21 mg/dl |
No |
Unknown |
Sales [52] |
M, 15 y |
L2-L3 |
Fever, urinary retention, Back pain, |
Low back pain and Not specified urinary retention |
Not performed |
Not available |
Staphylococcus aureus |
Hazelton [53] |
M, 16 d |
C3-C4 |
Fever, irritability |
- |
180 PMN, 9900 red blood cells |
Yes |
Methicillin-sensitive Staphylococcus aureus |
Mantadakis [46] |
F, 11 y |
T11-L4 |
Fever, lumbar pain |
Back pain |
Not performed |
No |
Methicillin-sensitive Staphylococcus aureus |
Rook [47] |
F, 15 y |
T3-T8 |
Right scapular pain, fever, chills with night sweats, headache, photophobia |
Right rhomboid muscle strain with spasm, acute febrile illness |
Normal |
Yes |
Methicillin-sensitive Staphylococcus aureus |
Tang [43] |
F, 7 wk |
T10-T12 |
Flaccid paraplegia |
Neoplasia |
Not performed |
Not available |
Staphylococcus aureus |
Kim [54] |
F, 10 y |
L3-L5 |
Fever, low back pain, radiating pain in both legs, saddle anesthesia, bladder and bowel dysfunction |
- |
Not performed |
Not available |
Staphylococcus aureus |
Shawar [55] |
F, 13 y |
Not available |
Fever, lumbar pain, headache, nausea, localized tenderness |
Viral infection |
WBCs>10,000/mm3, Undetectable glucose/protein |
Yes |
Methicillin-sensitive Staphylococcus aureus |
Raus [56] |
F, 3 m |
C5-C6 |
Neck stiffness, irritability, right upper extremity hypotonia, exaggerated tendon reflexes |
Meningoencephalitis |
Not available |
No |
Not available |
Bair-Meritt [42] |
F, 3 y |
L5-S1 |
Fever, malaise, right hip pain |
- |
Not performed |
Yes |
Oxacillin-sensitive Staphylococcus aureus |
Rood [57] |
M, 10 m |
L5-S1 |
Fever, back pain, gait change |
Bacterial infection of unknown location |
Not performed |
Not available |
Not available |
Prasad [58] |
F, 14 y |
Not available |
Abdominal tenderness |
Appendicitis |
Not performed |
Not available |
Not available |
Kiymaz [45] |
F, 10 y |
C2-C3 |
Fever, neck pain stiffness |
Meningitis |
Not performed |
No |
No microorganism isolated initially, 2 months later Streptococcus anginosus |
Flikweert [44] |
M, 7 y |
T3-T7 |
Fever, abdominal pain |
Appendicitis |
Not performed |
Not available |
Group A Streptococcus |
Our case |
F, 11 y |
T2-10 |
Fever, chest/back pain, LE weakness |
URTIs/Pneumonia/GBS |
Not performed |
Yes |
Methicillin-sensitive Staphylococcus aureus |
Citation: Tariq AS, Leena AS, Jawahir AS, Zakariya AA, Ali AS (2018) Spinal Epidural Abscess in Immunocompetent Child. J Brain Neursci 2: 005.
Copyright: © 2018 Al Saadi Tariq, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.