title: Spinal epidural abscess due to tropical pyomyositis in immunocompetent adolescents.
abstract: Pyomyositis, a suppurative infection of skeletal muscle, is a disease not frequently encountered by neurosurgical providers. While previously considered an infection localized to tropical and semitropical locations, clinical reports of pyomyositis in temperate climates have increased over the past decade. Paraspinal involvement is uncommon in pyomyositis; however, the potential exists for spread into the epidural space resulting in a spinal epidural abscess (SEA). Early diagnosis of an SEA is frequently hampered by the absence of specific signs, unfamiliarity with the disease, atypical manifestations, and a broad differential diagnosis that includes more common causes of back pain. To date, 1 such case of paraspinal pyomyositis associated with an SEA has been reported in the neurosurgical literature. The authors present 2 cases of pyomyositis with an SEA and review the epidemiology, pathophysiology, diagnostic workup, and management of this disorder.
authors.affiliation: Departments of Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
authors.forename: Donnell K
authors.initials: DK
authors.lastname: Bowen
authors.forename: Lex A
authors.initials: LA
authors.lastname: Mitchell
authors.forename: Mark W
authors.initials: MW
authors.lastname: Burnett
authors.forename: Veronica J
authors.initials: VJ
authors.lastname: Rooks
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000792:Angiography; D002648:Child; D020802:Epidural Abscess / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D011183:Postoperative Complications / Q000175:diagnosis; D011655:Pulmonary Embolism / Q000175:diagnosis; D052880:Pyomyositis / Q000175:diagnosis* / Q000601:surgery*; D013115:Spinal Canal / Q000473:pathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000601:surgery*; D013122:Spinal Diseases / Q000175:diagnosis* / Q000601:surgery*; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000473:pathology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed