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[Vertebral osteomyelitis with epidural abscess in a child with sickle cell disease]
M Rivierez1, D Heyman, M Bazin
1Service de Neurochirurgie.
Insights
A rare case of paraplegia in a child with sickle cell anemia highlights the importance of early diagnosis. Prompt treatment of spinal epidural abscesses, likely caused by salmonellae, is crucial for neurological recovery.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Sickle cell disease (SCD) predisposes children to infections, with salmonellosis being a common complication.
- Spinal epidural abscesses (SEAs) are rare but serious complications that can lead to neurological deficits.
Observation:
- A 6-year-old girl with SCD presented with paraplegia due to a thoracic epidural abscess.
- Imaging revealed T6 vertebral osteomyelitis, consistent with an infectious process.
Findings:
- Surgical decompression (laminotomy) and antibiotic therapy led to rapid neurological improvement.
- While cultures were negative, Salmonella was suspected as the causative agent, a known but unusual spinal complication in SCD.
Implications:
- This case underscores the need for high clinical suspicion for SEA in SCD patients with neurological symptoms.
- Early diagnosis using advanced imaging (MRI, CT) and prompt intervention are critical to prevent irreversible spinal cord compression and improve outcomes in pediatric SCD patients.
Abstract:
A case of paraplegia due to a thoracic epidural abscess in a 6-year-old black girl with sickle cell anemia is reported. MRI and CT scan showed abnormalities involving T6 vertebra which were consistent with osteomyelitis. A laminotomy, associated to antibiotic administration, permitted rapid neurological improvement. Although cultures were negative, the infection was probably due to salmonellae. Salmonellosis is a well-known complication in children with sickle cell disease but spinal localization is unusual. Its pathogenesis is unclear but immunological abnormalities associated to vascular obstructions by abnormal blood red cells have been advocated. The underlying etiology of vertebral abnormalities in these children is difficult to determine, but early diagnosis with modern investigations, as CT scan and MRI, is crucial to promptly begin therapy for osteomyelitis, minimizing the risk of spinal cord compression.