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Case report: Pseudomonas aeruginosa-related intervertebral discitis in a young boy with medulloblastoma
E Mazza1, F Spreafico, G Cefalo
1Department of Pediatric, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy. elemazza@yahoo.it
Abstract:
We report a case of a 15-year-old boy with desmoplastic medulloblastoma of the posterior fossa (T3M3, according to Chang classification) incompletely resected, with leptomeningeal and nodular spread in the posterior fossa and in the cervical and thoracic tracts of the spine, treated with sequential high dose iv chemotherapy and with hyperfractionated cranio-spinal radiotherapy. While on maintenance chemotherapy, the boy developed fever and septic status caused by Pseudomonas aeruginosa, and 1 week later also low back pain. Magnetic resonance imaging (MRI) demonstrated abnormal signal in the fourth ventricle and in the dorso-lumbar tract suggesting medulloblastoma recurrence, so he started with a chemotherapy program. Due to a worsening of back pain, a second MRI of the spine was performed that showed a spondilodiscitis of T11-T12 and L1-L2 discs. The histological and cultural examination of a fine-needle biopsy of the L1-L2 disc revealed the presence of P. aeruginosa. So patient was treated with intensive antibiotic therapy with resolution of the infection. Spondilodiscitis is a rare complication in neoplastic patients, maybe due to either immunodeficient status or invasive procedures such as lumbar puncture. This case demonstrates that MRI is a useful method for differentiating between infection and malignancy in the spine, but sometimes it may be difficult to distinguish metastatic tumor from a lesion due to spondilodiscitis. In this case surgicopathological assessment is crucial and mandatory.
Insights
A young patient with medulloblastoma developed a rare spinal infection (spondylodiscitis) caused by Pseudomonas aeruginosa. This case highlights the importance of distinguishing infection from tumor recurrence in cancer patients, emphasizing diagnostic challenges and the need for pathological confirmation.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Neuroradiology
Background:
- Desmoplastic medulloblastoma is a rare and aggressive brain tumor, often requiring multimodal treatment including chemotherapy and radiotherapy.
- Leptomeningeal spread in medulloblastoma poses significant treatment challenges and increases the risk of complications.
- Cancer patients, especially those immunocompromised or undergoing invasive procedures, are susceptible to opportunistic infections.
Observation:
- A 15-year-old boy with incompletely resected medulloblastoma developed fever and septic status due to Pseudomonas aeruginosa.
- Initial MRI suggested medulloblastoma recurrence in the spine, but subsequent imaging revealed spondylodiscitis.
- Histopathological analysis confirmed Pseudomonas aeruginosa as the causative agent of spinal infection.
Findings:
- Magnetic resonance imaging (MRI) can be instrumental in evaluating spinal lesions in cancer patients.
- Differentiating between metastatic tumor and infectious spondylodiscitis solely on MRI can be challenging.
- Surgicopathological assessment is crucial for accurate diagnosis and appropriate treatment of spinal complications in neoplastic patients.
Implications:
- This case underscores the potential for rare infectious complications like Pseudomonas aeruginosa spondylodiscitis in pediatric cancer patients.
- Prompt and accurate diagnosis is vital, as treatment strategies for infection and tumor recurrence differ significantly.
- The findings emphasize the critical role of histopathological confirmation when clinical and radiological findings are ambiguous, guiding effective patient management.
