title: Acute pyogenic necrotizing encephalomyelitis: a fulminant and fatal infection.
abstract: In this report the authors describe a rare case of a fulminant, pyogenic, necrotizing infection of the spinal cord and brain. Necrotizing lesions of the brain and spinal cord are usually infectious in origin and are associated with high rates of morbidity and death. Although the pathogens responsible have been identified in a few instances, the causal factors remain unknown in many cases. An 11-year-old girl developed acute, rapidly progressive paraplegia with bladder involvement and sensory loss below T-10. She had been treated recently for a Staphylococcus aureus infection of the knee joint precipitated by a penetrating injury with organic matter in the aftermath of a cyclone. Although appropriate antibiotic therapy was instituted, the spinal cord infection progressed to involve the entire spinal cord, brainstem, and brain. This fulminant course was marked by a rapid deterioration in the patient's clinical condition, ultimately leading to her death. Magnetic resonance imaging demonstrated a previously undescribed pattern of longitudinal enhancement along the spinal cord, as well as the white matter tracts in the brainstem and brain. The possible route of spread of infection along the neuraxis is postulated to be the potential space along the white matter tracts. Treatment is not standardized due to the rarity of the condition.
authors.affiliation: Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India. venkateshmadhugiri@gmail.com
authors.forename: Venkatesh Shankar
authors.initials: VS
authors.lastname: Madhugiri
authors.forename: Sudheer Kumar
authors.initials: SK
authors.lastname: Gundamaneni
authors.forename: Vani
authors.initials: V
authors.lastname: Santosh
authors.forename: Barath
authors.initials: B
authors.lastname: Jagadisan
authors.forename: Gopalakrishnan Madhavan
authors.initials: GM
authors.lastname: Sasidharan
authors.forename: Rathakrishnan V
authors.initials: RV
authors.lastname: Roopesh-Kumar
authors.forename: Awdhesh Kumar
authors.initials: AK
authors.lastname: Yadav
authors.forename: Manish
authors.initials: M
authors.lastname: Singh
authors.forename: Ramesh
authors.initials: R
authors.lastname: Ananthakrishnan
authors.forename: Nisha
authors.initials: N
authors.lastname: Pariarath
authors.forename: Niranjan
authors.initials: N
authors.lastname: Biswal
mesh_terms: D000208:Acute Disease; D001921:Brain / Q000382:microbiology* / Q000473:pathology*; D002648:Child; D018450:Disease Progression; D004679:Encephalomyelitis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007121:Immunocompetence; D007719:Knee Joint / Q000382:microbiology*; D008279:Magnetic Resonance Imaging; D009187:Myelitis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D009336:Necrosis; D010264:Paraplegia / Q000382:microbiology*; D013131:Spine / Q000382:microbiology* / Q000473:pathology*; D013203:Staphylococcal Infections / Q000150:complications* / Q000188:drug therapy; D013492:Suppuration