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Rare association between spinal epidural abscess and septic arthritis of the hip in pediatric age: Case report
Mansi Zied1, Berriri Marouene1, Romdhani Mokhtar1
1Department of Orthopedic Surgery, IBN EL JAZZAR University Hospital, Kairouan, Tunisia.
Insights
This case highlights a rare epidural abscess in a pediatric patient with septic hip arthritis. Early diagnosis and treatment are crucial for preventing severe complications in children.
Area of Science:
- Pediatric Infectious Diseases
- Neurosurgery
- Orthopedic Surgery
Background:
- Epidural abscess is a rare but serious infection, typically seen in older men.
- Staphylococcus aureus is the most common causative agent, often spreading hematogenously.
- Symptoms include fever, back pain, and neurological deficits.
Observation:
- A 10-year-old child presented with prolonged fever, back pain, and hip lameness.
- Spinal MRI revealed an epidural collection compressing the spinal cord from D4-D10.
- Hip MRI showed findings consistent with septic arthritis.
Findings:
- The patient underwent left hip arthrotomy, laminectomy, and epidural abscess drainage.
- Intravenous antibiotics were administered.
- The patient showed a favorable clinical and biological recovery.
Implications:
- This case underscores the importance of considering epidural abscess in pediatric patients with unexplained fever and pain.
- Prompt diagnosis and multidisciplinary management are essential to prevent neurological sequelae.
- There is a need for specific guidelines for pediatric spinal epidural abscess management.
Introduction And Importance:
Epidural abscess is a rare but serious infection. Although more commonly seen in men over 50, our case is notable for its occurrence in a pediatric patient, highlighting the unusual nature of this abscess at such a young age, particularly in conjunction with septic arthritis of the hip.
Case Presentation:
A 10-year-old child was admitted to pediatrics for investigation of a prolonged fever. The child presented with back pain associated with left hip lameness. An MRI of the spine showed an epidural collection extending from the 4th to the 10th dorsal vertebrae. This collection compressed the spinal cord. An MRI of the left hip showed an appearance consistent with septic arthritis. A left hip arthrotomy was performed, with laminectomy and drainage of the epidural abscess at D7. The patient was treated with antibiotics. The clinical and biological evolution was favorable.
Clinical Discussion:
Epidural abscess is a rare but serious infection, now more easily diagnosed by MRI. It is most often caused by hematogenous spread, mainly by Staphylococcus aureus. Symptoms include back pain, neurological signs and fever. Diagnosis is confirmed by MRI. Early diagnosis is essential to prevent neurological complications and death, as the disease can progress to paralysis. Treatment consists of intravenous antibiotics and surgical intervention as indicated.
Conclusion:
Early diagnosis of spinal epidural abscess is important to prevent neurological complications, sepsis and even death. It should be noted that there are no official recommendations or guidelines for the management of epidural spinal abscesses in the pediatric population.
