Primary pyomyositis (PM) is a rare bacterial infection of skeletal muscle usually restricted to tropical zones. Typically caused by Staphylococcus aureus, primary staphylococcal PM associated with an epidural abscess has not been reported before.
We present the first case of staphylococcal PM associated with an epidural abscess.
A 56-year-old woman.
Clinical follow-up at 9 months.
This 56-year-old woman presented with a sudden onset of left lumbar back pain and sciatica without prior illness. She was pyrexial on admission, with elevated inflammatory markers but with no obvious systemic source of sepsis.
Spinal magnetic resonance imaging and subsequent surgery revealed an erector spinae abscess causing an epidural abscess via the left L4/5 intervertebral foramen. Both back pain and sciatica were immediately improved postoperatively. Culture revealed S aureus as the sole organism sensitive to flucloxacillin. Intravenous therapy was converted to oral after 12 days once the erythrocyte sedimentation rate had normalized and she was asymptomatic. She remains asymptomatic and without clinical signs at the 9-month follow-up.
Spinal infection must always be considered when back pain and sciatica are associated with clinical signs of sepsis. We present the first case of staphylococcal PM associated with an epidural abscess.
"The combination of both these lesions in an immunocompetent person is extremely rare. Review of literature shows an isolated case report of pyomyositis with extradural abscess . Staphylococcus aureus was the usual pathogen in both these lesions  . "
[Show abstract][Hide abstract] ABSTRACT: Pyomyositis, a suppurative infection of skeletal muscle, is a disease not frequently encountered by neurosurgical providers. While previously considered an infection localized to tropical and semitropical locations, clinical reports of pyomyositis in temperate climates have increased over the past decade. Paraspinal involvement is uncommon in pyomyositis; however, the potential exists for spread into the epidural space resulting in a spinal epidural abscess (SEA). Early diagnosis of an SEA is frequently hampered by the absence of specific signs, unfamiliarity with the disease, atypical manifestations, and a broad differential diagnosis that includes more common causes of back pain. To date, 1 such case of paraspinal pyomyositis associated with an SEA has been reported in the neurosurgical literature. The authors present 2 cases of pyomyositis with an SEA and review the epidemiology, pathophysiology, diagnostic workup, and management of this disorder.
[Show abstract][Hide abstract] ABSTRACT: A 52-year-old lady was admitted with back pain, fever and reduced sensation in her left leg. Soon after admission she developed acute urinary retention. She underwent urgent MRI of the spine which showed an epidural abscess compressing the thecal sac which was treated with neurosurgical decompression and intravenous/oral antibiotics. Cultures from theatre grew Staphylococcus aureus sensitive to flucloxacillin. After 12 weeks of intravenous/oral antibiotics, she was discharged without any neurological disability.
Case Reports 09/2010; 2010. DOI:10.1136/bcr.11.2009.2505
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