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Extensive infectious myelitis post bariatric surgery
Elie Haddad1,2, Carmen Joukhadar3,4, Nabil Chehata5,6
1Infectious diseases department, Faculty of medicine, Saint-Joseph University, Hotel Dieu de France Hospital, Medical Sciences and Nursing Campus, Faculty of Medicine, Damascus Street, B.P. 11-5076, Riad El Solh, Beirut, 1107-2180, Lebanon. ehaddad@live.com.
Background:
Inflammatory myelopathy is an inflammatory neurological disorder of the spinal cord (myelopathy). It occurs in 1 (severe) to 8 (mild) cases/million per year. It is often referred to in the literature as "transverse myelitis" or "acute transverse myelitis". Myelopathy and by extension myelitis, can present as pyramidal (motor), sensory, and/or autonomic dysfunction to varying degrees. Symptoms typically develop over hours to days and worsen over days to weeks. Sensory symptoms usually present as paresthesia ascending from the feet with or without back pain at or near the level of the myelitis. A cervical level focal myelitis can present as sensory symptoms restricted to the feet without ascending extension. Motor symptoms often include weakness that preferentially affects the flexors of the legs and the extensors of the arms (pyramidal distribution of weakness) and can include sphincter dysfunction.
Case Presentation:
This is the case of a 55 years old female patient who develops sudden onset abdominal abscess one year after bariatric surgery that was complicated by an extensive infectious myelitis and cerebral abscesses without any cerebral symptoms. She received adequate antibiotherapy treatment with good evolution.
Conclusions:
This case is among the first in the medical literature that has occurred one year after bariatric surgery complicated by an abdominal and cerebral abscesses, and extensive infectious myelitis. We discussed all types of myelitis including, the autoimmune and the infectious origin. We showed the progressive evolution by showing MRI sequences. We emphasized about the importance of rapid initiation of the antibiotherapy as well as adding glucocorticoids.
Insights
A rare case of infectious myelitis and abscesses occurred one year after bariatric surgery. Prompt antibiotic therapy and glucocorticoids were crucial for recovery, highlighting the importance of timely intervention in such complex neurological conditions.
Area of Science:
- Neurology
- Infectious Diseases
- Surgical Complications
Background:
- Inflammatory myelopathy, also known as transverse myelitis, is a spinal cord disorder affecting 1-8 cases/million annually.
- It can manifest as motor, sensory, or autonomic dysfunction, with symptoms developing rapidly over hours to weeks.
- Common symptoms include ascending paresthesia, back pain, and pyramidal weakness, potentially leading to sphincter dysfunction.
Observation:
- A 55-year-old female developed an abdominal abscess one year post-bariatric surgery.
- This complication was associated with extensive infectious myelitis and cerebral abscesses, despite the absence of neurological symptoms.
- The patient received appropriate antibiotic treatment, leading to a positive clinical outcome.
Findings:
- This case represents one of the first documented instances of infectious myelitis and abscesses occurring a year after bariatric surgery.
- The study discusses both autoimmune and infectious etiologies of myelitis, supported by MRI evidence of disease progression.
- Rapid initiation of antibiotic therapy and the addition of glucocorticoids were emphasized as critical treatment components.
Implications:
- This case underscores the potential for delayed infectious complications following bariatric surgery, impacting the central nervous system.
- It highlights the importance of considering infectious myelitis in patients with a history of bariatric surgery presenting with neurological deficits or abscesses.
- The findings emphasize the critical role of prompt diagnosis and aggressive management, including antibiotics and corticosteroids, for favorable outcomes in infectious myelitis.
