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Tomori S, Korematsu S, Tanikawa S, Urushihara Y, Moriwaki K. Paraspinal muscle abscesses in children - A case report and review of the literature. Surg Neurol Int 2023; 14:3. [PMID: 36751462 PMCID: PMC9899453 DOI: 10.25259/sni_994_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023] Open
Abstract
Background Few pediatric cases with myositis and abscesses of the paraspinal muscles have been previously reported. Case Description We herein report on a 3-year-old patient who developed an epidural abscess in a paraspinal muscle abscess, after a complication of infectious impetigo due to atopic dermatitis. The child improved through the administration of an antibacterial drug. The median age of seven patients with a history of paraspinal muscle inflammation and muscle abscess was 12 years old (3-15-years-old), few of which had underlying diseases, with methicillin-sensitive Staphylococcus aureus being the main causative agent. Although the prognosis was well in many cases following the administration of antibacterial agents, there were also cases in which extensive lesions were found and neurological sequelae remained. Conclusion The current case was the youngest case ever reported of a paraspinal muscle abscess. Although pediatric cases are rare, in the episode of a fever of unknown origin and difficulty walking, paraspinal muscle abscesses should be cited as a differential diagnosis and appropriate early diagnostic imaging and treatment should be performed.
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Affiliation(s)
- Shinya Tomori
- Corresponding author: Shinya Tomori, Department of Pediatrics, Saitama Medical Center, Kawagoe, Japan.
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Abbati G, Abu Rumeileh S, Perrone A, Galli L, Resti M, Trapani S. Pelvic Pyomyositis in Childhood: Clinical and Radiological Findings in a Tertiary Pediatric Center. CHILDREN 2022; 9:children9050685. [PMID: 35626862 PMCID: PMC9139856 DOI: 10.3390/children9050685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022]
Abstract
Pyomyositis (PM) is an infrequent but increasing bacterial infection of the skeletal muscle, with muscles of the pelvis and thigh frequently involved. The diagnosis is often challenging, especially when a deep muscle is affected. We present a single-center pediatric cohort affected by pelvic PM. A retrospective analysis was performed, including children admitted to Meyer Children’s Hospital between 2010 and 2020. Demographic, anamnestic, clinical, laboratory, radiological and management data were collected. Forty-seven patients (range 8 days–16.5 years, 66% males) were selected. Pain (64%), functional limitations (40%) and fever (38%) were the most common presenting symptoms; 11% developed sepsis. The median time to reach the diagnosis was 5 days (IQR 3–9). Staphylococcus aureus was the most common organism (30%), Methicillin-Resistant S aureus (MRSA) in 14%. PM was associated with osteomyelitis (17%), arthritis (19%) or both (45%). The infection was multifocal in 87% of children and determined abscesses in 44% (40% multiple). Pelvic MRI scan, including diffusion-weighted imaging (DWI), always showed abnormalities when performed. Clinical and laboratory findings in pelvic PM are unspecific, especially in infancy. Nevertheless, the infection may be severe, and the suspicion should be higher. MRI is the most useful radiological technique, and DWI sequence could reveal insidious infections.
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Affiliation(s)
- Giulia Abbati
- Paediatric Residency, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy; (L.G.); (S.T.)
- Correspondence: ; Tel.: +39-3389919979
| | - Sarah Abu Rumeileh
- Paediatric Residency, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy; (L.G.); (S.T.)
| | - Anna Perrone
- Radiology Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy; (L.G.); (S.T.)
- Infectious Disease Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Massimo Resti
- Paediatric Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
| | - Sandra Trapani
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy; (L.G.); (S.T.)
- Paediatric Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
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Spinal epidural abscess from group A Streptococcus after varicella infection: a case report and review of the literature. Childs Nerv Syst 2014; 30:2129-33. [PMID: 25001474 DOI: 10.1007/s00381-014-2479-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Spinal epidural abscess (SEA) is a very rare condition in pediatric patients. Varicella zoster infection could be a predisposing factor, and SEA should be suspected in patients with signs of secondary bacterial infection and even mild neurological signs. CLINICAL CASE We describe here a case of a 30-month-old girl with a history of remitting varicella infection, diagnosed for a lumbar epidural abscess and sacro-ileitis, secondary to group A Streptococcus (GAS). DISCUSSION This is the third case of SEA from GAS reported in the literature in a pediatric population with varicella infection. We discuss here the clinical presentation and the diagnostic challenges for SEA in childhood through a review of the literature.
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Marshman LAG, Bhatia CK, Krishna M, Friesem T. Primary erector spinae pyomyositis causing an epidural abscess: case report and literature review. Spine J 2008; 8:548-51. [PMID: 18455117 DOI: 10.1016/j.spinee.2006.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 12/08/2006] [Accepted: 12/11/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Primary pyomyositis (PM) is a rare bacterial infection of skeletal muscle usually restricted to tropical zones. Typically caused by Staphylococcus aureus, primary staphylococcal PM associated with an epidural abscess has not been reported before. PURPOSE We present the first case of staphylococcal PM associated with an epidural abscess. STUDY DESIGN Case report. PATIENT SAMPLE A 56-year-old woman. OUTCOME MEASURES Clinical follow-up at 9 months. METHODS This 56-year-old woman presented with a sudden onset of left lumbar back pain and sciatica without prior illness. She was pyrexial on admission, with elevated inflammatory markers but with no obvious systemic source of sepsis. RESULTS Spinal magnetic resonance imaging and subsequent surgery revealed an erector spinae abscess causing an epidural abscess via the left L4/5 intervertebral foramen. Both back pain and sciatica were immediately improved postoperatively. Culture revealed S aureus as the sole organism sensitive to flucloxacillin. Intravenous therapy was converted to oral after 12 days once the erythrocyte sedimentation rate had normalized and she was asymptomatic. She remains asymptomatic and without clinical signs at the 9-month follow-up. CONCLUSION Spinal infection must always be considered when back pain and sciatica are associated with clinical signs of sepsis. We present the first case of staphylococcal PM associated with an epidural abscess.
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Affiliation(s)
- Laurence A G Marshman
- Department of Spinal Surgery, University Hospital of North Tees, Hardwick, Stockton, North Tees, TS19 8PE, United Kingdom.
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