title: [It starts as a Lumbovertebral syndrome and ends as an acute confusional state].
abstract: Here we report the case of a 19-year-old somalian man who has been admitted to our emergency department because of an important lumbago without trauma. The physical examination on arrival showed a diffuse painful percussion of the left paraspinal muscles without neurological impairment. The laboratory exams displayed a significant elevation of the inflammatory response (CRP 154 mg/l, procalcitonin 0,05 µg/l), the blood cultures were negative and a thoracic and lumbar computed tomography (CT) was not conclusive. The unclear clinical picture led to a magnetic resonance imaging, showing the presence of an abscess in the left thoraco-lumbar paraspinal musculature with ongoing invasion of the epidural space. The clinical picture became dramatic as the patient suddenly developed a frank nuchal rigidity associated with an acute confusional state, caused by the rupture of the abscess in the meningeal space with secondary meningitis, confirmed by a lumbar puncture, where S. aureus was found.
authors.affiliation: Département de médecine interne, Hôpitaux Universitaires de Genève.
authors.forename: Pietro
authors.initials: P
authors.lastname: Gianella
authors.affiliation: Unità di cure palliative, Ospedale Regionale di Bellinzona.
authors.forename: Tanja
authors.initials: T
authors.lastname: Fusi
authors.affiliation: Servizio di Malattie Infettive, Ospedale Regionale di Lugano.
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
mesh_terms: D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D054242:Emigrants and Immigrants; D020802:Epidural Abscess / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D017116:Low Back Pain / Q000209:etiology* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000601:surgery; D009460:Neurologic Examination; D064170:Paraspinal Muscles / Q000601:surgery; D012422:Rupture, Spontaneous; D012998:Somalia / Q000208:ethnology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000601:surgery; D013557:Switzerland; D013904:Thoracic Vertebrae / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D018836:Inflammation Mediators
keywords: MSSA; ascesso epidurale; epidural abscess; laminectomia; laminectomy; meningite; meningitis