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Holocord spinal epidural abscess.

Partha Sekhar Ghosh1, Tobias Loddenkemper, Manuel Buitrago Blanco

  • 1Pediatric Hospital Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA. ghoshp3@ccf.org

Journal of Child Neurology
|June 4, 2009
PubMed
Summary
This summary is machine-generated.

A rare holocord epidural abscess in an infant, caused by MRSA, was successfully treated with antibiotics alone. This case highlights a conservative approach for extensive spinal epidural abscesses in children, avoiding surgery and preventing neurological deficits.

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Area of Science:

  • Pediatric Infectious Diseases
  • Pediatric Neurology
  • Neurosurgery

Background:

  • Spinal epidural abscess (SEA) is uncommon in infants, often leading to severe neurological impairment if untreated.
  • Holocord epidural abscess, affecting the entire spinal cord, is exceptionally rare, particularly in pediatric populations.
  • Methicillin-resistant Staphylococcus aureus (MRSA) septicemia can manifest with diverse complications, including abscess formation.

Purpose of the Study:

  • To report an extremely rare case of holocord spinal epidural abscess in an infant.
  • To describe the successful conservative management of this extensive pediatric SEA.
  • To emphasize the potential for non-surgical treatment in select cases of infant spinal epidural abscess.

Main Methods:

  • A 7-month-old infant with MRSA septicemia presented with symptoms suggestive of spinal cord compression.
  • Magnetic resonance imaging (MRI) confirmed an extensive epidural abscess spanning from the cervical to the lumbar spine.
  • The patient was treated conservatively with a 6-week course of intravenous antibiotics.

Main Results:

  • The infant presented with fever, irritability, tachypnea, and decreased limb movement.
  • MRI revealed a holocord epidural abscess without associated osteomyelitis or discitis.
  • Following 6 weeks of antibiotic therapy, the patient showed complete neurological recovery at 3-month follow-up.

Conclusions:

  • Conservative management with intravenous antibiotics can be effective for holocord spinal epidural abscess in infants.
  • Early diagnosis and prompt treatment are crucial to prevent permanent neurological deficits.
  • This case adds to the limited literature on holocord SEA in children, supporting a non-surgical approach in select cases.