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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

422
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
422

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Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review
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Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

Published on: November 8, 2024

338

Nocardial epidural abscess: A case report.

Michael Galibov1, Michael Chung1, Faraz Jamal1

  • 1FK Johnson Rehabilitation Institute, Edison, NJ, USA.

Interventional Pain Medicine
|September 6, 2024
PubMed
Summary
This summary is machine-generated.

Primary Nocardial epidural abscess is rare, often complicating spinal infections. This case highlights delayed diagnosis and treatment challenges due to initial misidentification of Nocardia bacteria.

Keywords:
Case reportEpidural abscessEpidural steroid injectionsNocardia

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Area of Science:

  • Infectious Diseases
  • Neurosurgery
  • Medical Microbiology

Background:

  • Primary Nocardial epidural abscesses are infrequently reported, with scarce management guidelines.
  • Systemic Nocardiosis typically precedes spinal Nocardia infections.

Observation:

  • A patient with chronic low back pain and type 2 diabetes mellitus developed severe neurological deficits after epidural steroid injections.
  • Magnetic resonance imaging revealed an epidural abscess causing significant spinal canal stenosis.

Findings:

  • Initial treatment with vancomycin and piperacillin-tazobactam failed; surgical decompression was required.
  • Early cultures identified Mycobacterium species, leading to RIPE therapy, but symptoms persisted.
  • Subsequent cultures identified Nocardia, necessitating a switch to linezolid and sulfamethoxazole/trimethoprim, resulting in clinical improvement.

Implications:

  • Nocardia is a rare but critical cause of epidural abscesses, complicating antibiotic choices.
  • Delayed diagnosis and treatment can lead to adverse clinical outcomes.
  • This case underscores the importance of considering Nocardia in refractory spinal infections.