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Intramedullary spinal cord abscess
B S Koppel1, M Daras, K R Duffy
1Department of Neurology, New York Medical College, Metropolitan Hospital, New York.
Abstract:
Viral myelitis and bacterial epidural infections are common in intravenous drug abusers, but primary infections of the spinal cord are extremely rare. We report a 50-year-old active intravenous drug user who developed tetraplegia from an intramedullary abscess caused by Pseudomonas cepacia. Despite neurosurgical drainage and appropriate antibiotic therapy, no improvement was seen. Earlier intervention and a high index of suspicion is required in patients with a history of intravenous drug abuse and spinal cord symptoms.
Insights
Intravenous drug use can lead to rare spinal cord infections. This case highlights a Pseudomonas cepacia intramedullary abscess causing tetraplegia, emphasizing the need for early diagnosis in at-risk patients.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Intravenous drug abuse (IVDA) is associated with various infections, but primary spinal cord infections are uncommon.
- Bacterial epidural infections and viral myelitis are more frequently observed in IVDA populations.
Observation:
- A 50-year-old active intravenous drug user presented with tetraplegia.
- The patient was diagnosed with an intramedullary abscess of the spinal cord.
Findings:
- The abscess was caused by Pseudomonas cepacia, a rare pathogen in this context.
- Neurosurgical drainage and antibiotic therapy did not result in clinical improvement.
Implications:
- This case underscores the importance of a high index of suspicion for spinal cord pathology in IVDA patients presenting with neurological deficits.
- Prompt diagnosis and intervention are crucial for potentially improving outcomes in rare spinal cord infections.
- Pseudomonas cepacia should be considered in the differential diagnosis of spinal infections in intravenous drug users.