Abscesso epidural espinhal na adolescência: relato de caso

• Main Authors: Aléxia Alves Cabral (Author), Cecília Pereira Silva (Author), Amanda Freire de Almeida (Author), Christian Candido Ferreira (Author), Ricardo Kalil Laviola (Author), Gabriel Kalil Laviola Oliveira e Silva (Author)
• Format: Book
• Published: Sociedade Brasileira de Pediatria, 2023-06-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.25060/residpediatr-2023.v13n2-512; 2236-6814
• Keywords: epidural abscess; anesthesia; spinal; adolescent; Pediatrics; RJ1-570
• Source: Residência Pediátrica, Vol 13, Iss 2 (2023)

Spinal epidural abscess (SEA) is a rare infectious emergency and capable of causing severe neurological deficits, especially in childhood. The mortality rate in adults varies from 5 to 23%, but in children the rates are even lower. This report aims to contribute to the scientific field by discussing a case of SEA in pediatrics. It is a teenager, 17 years old, presenting fever, low back pain and sebaceous cyst infected on her back for three days. She reports a history of drainage two days ago and a cesarean section with spinal anesthesia a year ago. Magnetic resonance imaging (MRI) of the lumbar showed posterior L1-L4 epidural collection. Epidural abscess drainage surgery was performed, with L3-L4 laminectomy, and positive culture for Methicillin-resistant Staphylococcus aureus (MRSA), sensitive to Vancomycin and Rifampicin. She was discharged after 21 days of intravenous Vancomycin, with a prescription for oral Rifampicin for three weeks. Previous skin infection is considered a classic precedent of SEA, suggesting that the patients condition was preceded by furunculosis. The microorganism responsible for 86% of SEA cases in childhood is Staphylococcus aureus. Back pain after spinal anesthesia, fever, skin infection and possible condition of immunosuppression indicated investigation for SEA. Gadolinium-contrast MRI corresponds to the gold standard diagnostic approach for SEA. The suspicion of the disease in pediatrics is extremely important in front of fever, back pain and spinal sensitivity, and should receive due attention and investigation before an indicative clinic.