Epidural abscess in a patient with dorsal hyperhidrosis.
OBJECTIVE
To report the management of a patient who developed a lumbar epidural abscess when an epidural catheter was placed three years after a thoracic sympathectomy. The possible contribution of hyperhidrosis is discussed.


METHODS
A 62-yr-old male had compensatory hyperhidrosis in his back after thoracic sympathectomy. The patient, who suffered from thromboangeitis obliterans, underwent lumbar (L2-3) epidural catheterization in order to improve arterial circulation and ameliorate resting pain in his left leg. On the third day after catheterization, the patient complained of a dull pain in his back. Emergency magnetic resonance imaging revealed a 12-mm abscess in the epidural space. On the tenth day after catheterization, laminotomy at the 3-4 lumbar vertebrae and local drainage were performed. A 14-mm abscess was removed from the epidural space. The patient was discharged on day 21 after catheterization without any disability.


CONCLUSIONS
Special precautions against infection may be necessary in patients with hyperhidrosis in the area where continuous epidural catheterization is attempted.
Department of Anesthesiology and Reanimatology, Gunma University School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Japan.
Masanobu
M
Ide
Shigeru
S
Saito
Masayuki
M
Sasaki
Fumio
F
Goto
D000767:Anesthesia, Epidural / Q000009:adverse effects*; D020802:Epidural Abscess / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D006945:Hyperhidrosis / Q000150:complications* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013122:Spinal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D013562:Sympathectomy / Q000009:adverse effects