Isolated Myelitis and Intramedullary Spinal Cord Abscess in Melioidosis—A Case Report

Neuromelioidosis is a severe tropical infection with high morbidity and mortality. Isolated myelitis is an extremely rare manifestation of melioidosis which may evade diagnosis. We report a 69-year-old diabetic male patient who presented with acute flaccid paraplegia and longitudinally extensive myelitis and no systemic symptoms. MRI of spinal cord showed lower dorsal cord and conus T2 hyperintensity and microabscesses with dural enhancement. The diagnosis was clinched with blood culture growing Burkholderia pseudomallei. He rapidly developed colitis, septicemia and multiorgan dysfunction and succumbed to the illness in spite of antibiotics and aggressive supportive care. The case highlights that melioidosis should be considered as a differential diagnosis of infectious myelitis, especially in the tropics. Presence of a neutrophilic blood and cerebrospinal fluid picture and microabscesses in spinal cord are important diagnostic clues. The outcome is dismal unless the diagnosis is considered early in the disease course and managed expeditiously with sensitive antibiotics.

A Rare Case of an Intramedullary Spinal Cord Abscess Due to Escherichia coli in a Pediatric Patient

Spinal cord abscess is a rare entity, particularly in the pediatric population. Spinal cord abscesses can be located in extradural, subdural and intradural (intramedullary or extramedullary) regions of the cord. Among these locations, intramedullary is extremely uncommon. There have been few case reports of intramedullary spinal cord abscess since its first description in 1830. We describe a 2 year-old boy with a history of neonatal meningitis due to E.coli who presented with refusal to walk and was subsequently found to have intramedullary spinal cord abscesses at multiple levels. Culture of the abscesses again revealed E.coli. The patient was noted to have a pit located just superiorly to his sacral spine. Imaging revealed the presence of a dorsal dermal sinus tract. It is important to evaluate anatomical abnormalities, especially in the setting of serious bacterial infections, such as meningitis, as they have the potential to serve as a reservoir for infection.

Spinal Intramedullary Abscess Secondary to Dermal Sinus in Children

Introduction Congenital dermal sinuses (CDS) are uncommon lesions. They are most often noted in lumbosacral region and may lead to meningitis or spinal abscess. Intramedullary spinal cord abscess (IMSCA) due to CDS is rare and often co-exists with an inclusion tumor such as dermoid/epidermoid cyst. Materials and Methods Literature review was done to analyze all cases of pediatric IMSCA secondary to CDS by searching online databases starting from the oldest case reported. Results Only 50 cases have been reported and were analyzed. Mean age was 22.6 months (range 1 month–15 years). Fever, acute flaccid lower limb weakness, and urinary disturbances were the most common presenting features. Dermal sinus was commonest in lumbosacral region. Inclusion cysts were observed in 50% of cases. Staphylococcus aureus was the most the common organism. Mean follow-up duration was 18.2 months (range 1 week–156 months). Majority of the cases underwent multilevel laminectomy with myelotomy and drainage of abscess. Outcome was good-to-excellent in around 60% cases with four deaths. Presence of fever and limb weakness was significantly associated with poor outcomes. Conclusion Intramedullary abscess secondary to CDS is very rare. Complete sinus tract excision, myelotomy and drainage of abscess, and decompression of co-existent inclusion cysts with prolonged antibiotic therapy remain the standard treatment. Approximately 60% cases achieve good outcomes. Fever and limb weakness portend poorer outcomes than those without.

Intramedullary Spinal Cord Abscess: Illustration of Two Cases and Review of Literature

Intramedullary spinal cord abscess is a rare infection of the spinal cord with less than 120 cases reported since its first description by Hart in 1830. It is usually associated with abnormalities of the spinal cord or documented source of infection or immunodeficiency, requiring clinical radiological suspicion for accurate diagnosis. The first case is a middle-aged healthy woman without any underlying risk factors, presented with progressive paraparesis, in whom prompt, accurate diagnosis with contrast magnetic resonance imaging, diffusion-weighted imaging, and apparent diffusion coefficient mapping followed by early surgery was possible, which resulted in the favorable neurological outcome. The second case is a 10-year-old boy with paraparesis whose definite treatment and surgery was delayed due to a delay in accurate clinical and radiological diagnosis which resulted in poor outcomes. Hence, we try to establish that prompt diagnosis and surgical treatment can result in a favorable neurological outcome, though the prognosis, in general, is poor in this clinical condition. A review of literature in support of our cases is given.