title: A case of autonomically mediated pain due to spinal epidural abscess in an adolescent female.
abstract: Spinal epidural abscess (SEA) is a rare disease in children without predisposing risk factors. Atypical presentations of SEA without the classic triad of fever, back pain, and neurological signs, have previously been described. We report an atypical presentation of an acute SEA in a previously healthy adolescent female. This 15-year-old patient presented with right shoulder pain in the absence of the fever, back pain, or long-tract signs; therefore, the diagnosis of the spinal pathology was delayed. Eventually, a thoracic SEA was identified by gadolinium-enhanced magnetic resonance imaging and treated with surgical decompression followed by intravenously administered antibiotics. The patient's course was complicated by chronic headache. Our experience adds to the literature a case that demonstrates the difficulty in diagnosis of atypical presentations of SEA in previously healthy children. In addition, referred or autonomically mediated pain should be considered in unusual pain presentations. Children with significant extremity or abdominal pain should be considered for the possibility of sympathetically mediated pain syndrome due to a thoracic-level spinal cord lesion such as a SEA.
authors.affiliation: Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA. jrook@westernu.edu
authors.forename: James L
authors.initials: JL
authors.lastname: Rook
authors.forename: David
authors.initials: D
authors.lastname: Duffey
authors.forename: Steven
authors.initials: S
authors.lastname: DeRoos
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001416:Back Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D019299:Decompression, Surgical / Q000379:methods; D003937:Diagnosis, Differential; D020802:Epidural Abscess / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013904:Thoracic Vertebrae
chemical_list: D000900:Anti-Bacterial Agents