ABSTRACT
El absceso epidural espinal, una patología poco frecuente, presenta una incidencia de un caso cada 100 000 individuos, y se observa un aumento debido al incremento de factores de riesgo, tales como diabetes mellitus, anomalías espinales, tatuajes, acupuntura, analgesia epidural, sumado a una mayor disponibilidad de métodos de imágenes. Es una colección purulenta localizada entre la duramadre y el canal medular. Los gérmenes más comunes son Staphylococcus aureus y bacterias Gram-negativas. Sin tratamiento oportuno, evoluciona a la compresión medular y secuelas neurológicas permanentes. Una niña de 11 años se presentó con fiebre de 48 horas de evolución, dolor lumbar izquierdo, marcha antálgica con envaramiento lumbar. El examen neurológico era normal. Sobre los miembros inferiores, se observaban lesiones ampollares destechadas. La resonancia nuclear magnética mostró una imagen compatible con absceso epidural espinal. Evolucionó favorablemente. El tratamiento consistió en drenaje quirúrgico y antibióticos por 6 semanas. Del cultivo del material obtenido, creció Staphylococcus aureus meticilino sensible.
Spinal epidural abscess is an uncommon pathology. It has an incidence of one case per 100 000 individuals. An increase is observed due to the raise of risk factors such as diabetes mellitus, spinal abnormalities, tattoos, acupuncture, epidural analgesia, and a greater availability of imaging methods. It is a purulent collection located between the dura and the medullary canal. The most common germs are Staphylococcus aureus and Gram-negative bacteria. Without timely treatment, it evolves to medullary compression and permanent neurological sequelae. An 11-year-old girl was admitted with fever of 48 hs evolution, left lower back pain, antalgic gait with lumbar stiffness. Neurological examination was normal. Blunt blistering lesions were observed on lower limbs. Magnetic resonance imaging showed an image compatible with spinal epidural abscess. The evolutionwas favorable. Treatment consisted of surgical drainage and antibiotics for 6 weeks. From the culture of the material obtained, methidllin-sensitive Staphylococcus aureus was isolated.
Subject(s)
Humans , Female , Child , Spinal Cord Diseases/microbiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Epidural Abscess/diagnosis , Epidural Abscess/drug therapy , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/drug therapyABSTRACT
ABSTRACT: CONTEXT: Paracoccidioidomycosis is a systemic form of mycosis that spreads hematogenously, secondarily to reactivation of lung infection or infection at another site or to new exposure to the causative agent. Few cases of bone involvement have been reported in the literature and involvement of the spine is extremely rare. CASE REPORT: We describe a case of a 68-year-old male patient with spondylodiscitis at the levels L4-L5 caused by presence of the fungus Paracoccidioides brasiliensis, which was diagnosed through percutaneous biopsy. The patient was treated with sulfamethoxazole and trimethoprim for 36 months, with complete resolution of the symptoms. CONCLUSION: Spondylodiscitis caused by the fungus Paracoccidioides brasiliensis is uncommon. However, in patients with chronic low-back pain who live or used to live in endemic regions, this infection should be considered as a possible differential diagnosis.
RESUMO: CONTEXTO: Paracoccidioidomicose é uma micose sistêmica de disseminação hematogênica, secundária a reativação de uma infecção pulmonar ou de outro sítio, ou a uma nova exposição ao agente causador. Poucos casos de envolvimento ósseo são relatados na literatura, e o acometimento da coluna vertebral é extremamente raro. RELATO DE CASO: Descrevemos o caso de um paciente masculino de 68 anos, apresentando espondilodiscite no nível L4-L5, causada pela presença do fungo Paracoccidioides brasiliensis, diagnosticada após biópsia percutânea. O paciente foi tratado com sulfametoxazol e trimetoprim por 36 semanas, com resolução completa dos sintomas. CONCLUSÃO: A espondilodiscite causada pelo fungo Paracoccidioides brasiliensis é incomum, mas, em pacientes portadores de lombalgia crônica que viveram ou vivem em regiões endêmicas, deve ser considerada como um possível diagnóstico diferencial.
Subject(s)
Humans , Middle Aged , Aged , Paracoccidioidomycosis/diagnostic imaging , Spinal Cord Diseases/diagnostic imaging , Paracoccidioides/isolation & purification , Paracoccidioidomycosis/microbiology , Paracoccidioidomycosis/pathology , Spinal Cord Diseases/microbiology , Spinal Cord Diseases/pathology , Biopsy , Magnetic Resonance Imaging , Low Back Pain/diagnosis , Diagnosis, DifferentialABSTRACT
Intravesical therapy with live-attenuated Mycobacterium bovis strain have demonstrated to be effective in the treatment of recurrent and high-grade superficial bladder tumors. The use of this therapy is widely extended; however spreading of bacillus from the injection site could be one rare complication that may cause infection in different locations. An appropriate anamnesis is very important to establish an etiological diagnostic of possible infections caused by M. bovis BCG. Laboratory diagnosis at species level is difficult because of the high genetic similarity (99.9%) with the other member of Mycobacterium tuberculosis complex. We present a case report who developed tuberculous spondylodiscitis by M. bovis BCG, which had a history of intravesical instillation for treatment of bladder cancer.
Las instilaciones intravesicales con la cepa viva atenuada de Mycobacterium bovis han demostrado su eficacia en el tratamiento de cáncer urotelial de vejiga. Su uso está ampliamente difundido; sin embargo, una reacción adversa infrecuente es la extravasación del bacilo del lugar de acción pudiendo causar infecciones en otras localizaciones. Una correcta anamnesis del paciente ayuda a orientar la etiología de posibles infecciones relacionadas con éste microorganismo. El diagnóstico de laboratorio a nivel de especie es dificultoso ya que comparte un 99,9% de identidad genética con los otros miembros del complejo Mycobacterium tuberculosis. Se presenta el caso de un paciente que desarrolló una espondilodiscitis tuberculosa por M. bovis BCG, el cual tenía antecedentes de instilaciones intravesicales para el tratamiento del cáncer de vejiga.
Subject(s)
Aged , Humans , Male , Abscess/microbiology , Discitis/microbiology , Mycobacterium bovis , Spinal Cord Diseases/microbiology , Abscess/diagnosis , Discitis/diagnosis , Magnetic Resonance Imaging , Spinal Cord Diseases/diagnosisSubject(s)
Humans , Male , Middle Aged , Central Nervous System Fungal Infections/microbiology , Paracoccidioidomycosis/complications , Spinal Cord Diseases/microbiology , Central Nervous System Fungal Infections/pathology , Magnetic Resonance Imaging , Paracoccidioidomycosis/pathology , Rare Diseases/complications , Rare Diseases/microbiology , Spinal Cord Diseases/pathologyABSTRACT
Affection of the spinal cord with schistosome eggs cause many neurologic complications. The resulting mass may give rise to controversy in diagnosis. This can be more or less easily judged by MRI. However, radical surgical excision is not always recommended. Biopsied materials for histopathological studies should be done first before any surgical treatment
Subject(s)
Humans , Male , Female , Spinal Cord Diseases/microbiology , Neurologic Manifestations , Spinal Cord/parasitologyABSTRACT
Se presenta una serie de 7 pacientes con SIDA en quienes se diagnosticó poliradiculomielopatía causada por Citomegalovirus (CMV-PRAM), con el objetivo de evaluar la eficacia del tratamiento con ganciclovir, foscarnet, o la combinación de ambos agentes. Se realizaron evaluaciones clínicas y neurológicas al momento de presentación y durante el tratamiento para el CMV. La fuerza muscular fue establecida de acuerdo a la escala del Medical Research Council (MRC). Se clasificó la respuesta al tratamiento de acuerdo al grado de mejoría en la fuerza muscular. En 6 de los 7 pacientes se observó una mejoría en la fuerza muscular con tratamiento anti-CMV alcanzando grado 4, o una mejoría de por lo menos 3 grados de acuerdo a la escala MRC. El paciente restante tuvo una respuesta intermedia. CMV-PRAM puede ser tratada con ganciclovir o la combinación de ganciclovir y foscarnet con buenos resultados.
Subject(s)
Adult , Female , Humans , AIDS-Related Opportunistic Infections/complications , Antiviral Agents/therapeutic use , Cytomegalovirus Infections/complications , Foscarnet/therapeutic use , Ganciclovir/therapeutic use , Polyradiculopathy/drug therapy , Polyradiculopathy/microbiology , Spinal Cord Diseases/drug therapy , Spinal Cord Diseases/microbiology , Antiviral Agents , Clinical Trials as Topic , Cytomegalovirus Infections/drug therapy , Drug Therapy, Combination , Electromyography , Foscarnet , Ganciclovir , Muscle Tonus/drug effects , Treatment Outcome , Urinary Retention/drug therapy , Urinary Retention/microbiologyABSTRACT
El absceso espinal epidural (AEE), representa para el médico una patología de dificil diagnóstico, tanto por su baja incidencia y por ende, bajo índice de sospecha, como por la reducida sensibilidad de los métodos imagenológicos de rutina: radiología simple de columna, cintigrafía ósea e incluso, tomografía axial computada. Se presenta un caso de AEE tratado en el servicio de medicina. De discuten los aspectos anatómicos, patogénicos, microbiológicos, diagnósticos y terapéuticos de la enfermedad, enfatizándo que en la precocidad del diagnóstico, se encuentra el mejor pronóstico de este cuadro