Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review.
Introduction: Epidural injections are frequent and safe procedures. Severe complications are infrequent, and they have been reported in elderly comorbid patients with predisposing factors. The objectives of this work are to present a case of an extensive epidural lumbar abscess in a young non-comorb...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2023
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/37392 |
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I10-R327-article-37392 |
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ojs |
| institution |
Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
| container_title_str |
Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Inglés |
| format |
Artículo revista |
| topic |
epidural abscess spine infections injections epidural abscesso epidural columna vertebral infecciones inyecciones epidurales abscesso epidural coluna vertebral infecções injeções epidurais |
| spellingShingle |
epidural abscess spine infections injections epidural abscesso epidural columna vertebral infecciones inyecciones epidurales abscesso epidural coluna vertebral infecções injeções epidurais Holc, Fernando Albani Forneris, Agustin Camino Willhuber, Gaston Kido, Gonzalo Gruenberg, Marcelo Sola, Carlos Pereira Duarte, Matias Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review. |
| topic_facet |
epidural abscess spine infections injections epidural abscesso epidural columna vertebral infecciones inyecciones epidurales abscesso epidural coluna vertebral infecções injeções epidurais |
| author |
Holc, Fernando Albani Forneris, Agustin Camino Willhuber, Gaston Kido, Gonzalo Gruenberg, Marcelo Sola, Carlos Pereira Duarte, Matias |
| author_facet |
Holc, Fernando Albani Forneris, Agustin Camino Willhuber, Gaston Kido, Gonzalo Gruenberg, Marcelo Sola, Carlos Pereira Duarte, Matias |
| author_sort |
Holc, Fernando |
| title |
Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review. |
| title_short |
Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review. |
| title_full |
Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review. |
| title_fullStr |
Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review. |
| title_full_unstemmed |
Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review. |
| title_sort |
extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised patient. case report and literature review. |
| description |
Introduction: Epidural injections are frequent and safe procedures. Severe complications are infrequent, and they have been reported in elderly comorbid patients with predisposing factors. The objectives of this work are to present a case of an extensive epidural lumbar abscess in a young non-comorbid male patient after a therapeutic L5-S1 injection and a literature review about this subject.
Case Presentation
An otherwise healthy 24-year-old man who present a case of an extensive epidural lumbar abscess after a therapeutic nerve root block due to a disc herniation. After 7 days of fever and low back pain, he required two surgical interventions and intravenous antibiotic therapy.
We reviewed 18 patients with epidural abscess consequence of spinal injections. Their mean age was 54.5 y.o, 66.5% were male, and 66.5% had at least one predisposing risk factor. Symptoms Onset occurred at 8 days on average after the procedure, but the correct diagnosis was made at the 25th-day average. Only 22% presented the classic diagnostic triad, the most frequently isolated germ was Staphylococcus Aureus (66%) and 89% were treated surgically with a 33% rate of complete recovery, 17% mortality and 28% remained with neurological sequelae.
Conclusion:
Epidural abscesses are infrequent and serious, complication after spinal diagnostic and therapeutic injections, even in young patients without comorbidities. We consider it fundamental to maintain a diagnostic suspicion, even in this subgroup of patients. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2023 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/37392 |
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I10-R327-article-373922023-07-10T12:03:20Z Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review. Absceso epidural espinal posterior a bloqueo terapéutico en un paciente joven sin factores de riesgo. Reporte de caso y revisión de la Literatura Abscesso epidural espinhal extenso após injeção na raiz do nervo em um paciente jovem não imunocomprometido. Relato de caso e análise literária. Holc, Fernando Albani Forneris, Agustin Camino Willhuber, Gaston Kido, Gonzalo Gruenberg, Marcelo Sola, Carlos Pereira Duarte, Matias epidural abscess spine infections injections epidural abscesso epidural columna vertebral infecciones inyecciones epidurales abscesso epidural coluna vertebral infecções injeções epidurais Introduction: Epidural injections are frequent and safe procedures. Severe complications are infrequent, and they have been reported in elderly comorbid patients with predisposing factors. The objectives of this work are to present a case of an extensive epidural lumbar abscess in a young non-comorbid male patient after a therapeutic L5-S1 injection and a literature review about this subject. Case Presentation An otherwise healthy 24-year-old man who present a case of an extensive epidural lumbar abscess after a therapeutic nerve root block due to a disc herniation. After 7 days of fever and low back pain, he required two surgical interventions and intravenous antibiotic therapy. We reviewed 18 patients with epidural abscess consequence of spinal injections. Their mean age was 54.5 y.o, 66.5% were male, and 66.5% had at least one predisposing risk factor. Symptoms Onset occurred at 8 days on average after the procedure, but the correct diagnosis was made at the 25th-day average. Only 22% presented the classic diagnostic triad, the most frequently isolated germ was Staphylococcus Aureus (66%) and 89% were treated surgically with a 33% rate of complete recovery, 17% mortality and 28% remained with neurological sequelae. Conclusion: Epidural abscesses are infrequent and serious, complication after spinal diagnostic and therapeutic injections, even in young patients without comorbidities. We consider it fundamental to maintain a diagnostic suspicion, even in this subgroup of patients. Introducción: Los bloqueos perirradiculares son una práctica habitual y segura. Las complicaciones severas, como los abscesos epidurales, son infrecuentes y han sido reportadas en pacientes añosos con comorbilidades o factores predisponentes. El objetivo de este trabajo es presentar un paciente joven sin antecedentes con diagnóstico de absceso epidural posterior a un bloqueo terapéutico y la revisión de la literatura al respecto. Presentación del caso: Un hombre de 24 años, previamente sano, presenta un caso de absceso epidural lumbar extenso, luego de un bloqueo perirradicular por una hernia de disco. Tras 7 días de fiebre y lumbalgia, precisó dos intervenciones quirúrgicas y antibioticoterapia intravenosa. Recabamos la información de 18 casos junto al nuestro, de pacientes con diagnóstico de absceso epidural como consecuencia de una infiltración espinal. El promedio de edad de los pacientes fue de 54,5 años, 66,5% fueron de sexo masculino y 66,5% presentaba al menos un factor de riesgo predisponente. La aparición de síntomas luego del bloqueo ocurrió en promedio a los 8 días, pero el diagnóstico de absceso se realizó a los 24 días en promedio. La tríada diagnóstica clásica solo estuvo presente en el 22%, el germen más frecuentemente aislado fue el Staph. aureus (66%) y un 89% fue tratado de manera quirúrgica con una tasa del 33% de recuperación completa, 17% de mortalidad y 28% de secuela neurológica. Conclusión: Los abscesos epidurales son una complicación infrecuente, grave y rara de los procedimientos diagnósticos y terapéuticos espinales, incluso en pacientes jóvenes sin comorbilidades. Consideramos menester mantener la sospecha diagnóstica, incluso en este subgrupo de pacientes. Introdução: As injeções epidurais são procedimentos frequentes e seguros. Complicações graves são infrequentes e foram relatadas em pacientes idosos com comorbidades com fatores predisponentes. Os objetivos deste trabalho são apresentar um caso de abscesso lombar epidural extenso em paciente jovem não comórbido após injeção terapêutica de L5-S1 e revisão da literatura sobre o assunto. Apresentação do caso Um homem de 24 anos, saudável, que apresenta um caso de abscesso epidural lombar extenso após um bloqueio terapêutico de raiz nervosa devido a uma hérnia de disco. Após 7 dias de febre e lombalgia, necessitou de duas intervenções cirúrgicas e antibioticoterapia endovenosa. Revisamos 18 pacientes com conseqüência de abscesso epidural de injeções espinhais. A idade média deles era 54,5 anos, 66,5% eram do sexo masculino e 66,5% tinham pelo menos um fator de risco predisponente. O início dos sintomas ocorreu em média 8 dias após o procedimento, mas o diagnóstico correto foi feito em média no 25º dia. Apenas 22% apresentaram a tríade diagnóstica clássica, o germe mais isolado foi o Staphylococcus Aureus (66%) e 89% foram tratados cirurgicamente com 33% de recuperação completa, 17% de mortalidade e 28% permaneceram com sequelas neurológicas. Conclusão: Os abscessos epidurais são infrequentes e graves, complicações após o diagnóstico de coluna vertebral e injeções terapêuticas, mesmo em pacientes jovens sem comorbidades. Consideramos fundamental manter a suspeita diagnóstica, mesmo neste subgrupo de pacientes. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2023-03-31 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion text/html application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/37392 10.31053/1853.0605.v80.n1.37392 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 80 No. 1 (2023); 59-65 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 80 Núm. 1 (2023); 59-65 Revista da Faculdade de Ciências Médicas de Córdoba; v. 80 n. 1 (2023); 59-65 1853-0605 0014-6722 10.31053/1853.0605.v80.n1 eng https://revistas.unc.edu.ar/index.php/med/article/view/37392/41054 https://revistas.unc.edu.ar/index.php/med/article/view/37392/40954 Derechos de autor 2023 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0 |