title: Pediatric spinal epidural abscess in an immunocompetent host without risk factors: Case report and review of the literature.
abstract: Spinal epidural abscesses (SEAs) are unusual bacterial infections, with possible devastating neurologic sequelae. Despite abundance of case series in adults, reports in children are scanty. We describe a spontaneous SEA due to methicillin susceptible Staphylococcus aureus (MSSA) in a previously healthy 15-year old male, and we perform a literature review regarding management of pediatric SEAs without risk factors, from 2001 to 2014. We found a total of 12 cases (8 males, average age 9.6 years). Clinical presentation was mainly fever, back pain and elevation of inflammation markers. All cases were initially misdiagnosed. Lumbar puncture was performed in 36% of patients. Etiological diagnosis was obtained in 8 cases. MSSA was isolated in 4 patients, methicillin-resistant S. aureus in 1 patient, and S. aureus with unknown susceptibility patterns in 2 cases. The average of therapy duration was 6 weeks. Patients' spine was always evaluated by gadolinium-enhanced magnetic resonance imaging; most abscesses were localized at thoracic and lumbar area, without osteomyelitis. In 8 cases, laminectomy and/or abscess drainage were performed in association with medical therapy; 3 cases were successfully treated with antimicrobial therapy only; no data were available in one case. A good outcome was obtained in all patients, except a reported residual headache and paraspinal pain lasting for 3 years. The rarity and the possible differential diagnosis can lead to underestimate SEA occurrence in children without risk factors. It seems therefore essential to maintain a high attention to pediatric SEAs. A prompt diagnosis and adequate therapy are essential prognostic factors for remission.
authors.affiliation: University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Vergori
authors.affiliation: Unit of Neuroimaging and Neurointervention, Hospital Department of Neurological and Sensorial Sciences, University Hospital of Siena, Siena, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Cerase
authors.affiliation: University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Migliorini
authors.affiliation: Unit of Neurosurgery, Hospital Department of Neurological and Sensorial Sciences, University Hospital of Siena, Siena, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Pluchino
authors.affiliation: Unit of Neurosurgery, Hospital Department of Neurological and Sensorial Sciences, University Hospital of Siena, Siena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oliveri
authors.affiliation: Unit of Neuroimaging and Neurointervention, Hospital Department of Neurological and Sensorial Sciences, University Hospital of Siena, Siena, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Arrigucci
authors.affiliation: University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena, Italy; Department of Medical Biotechnologies, University of Siena, Siena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: De Luca
authors.affiliation: University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena, Italy; Department of Medical Biotechnologies, University of Siena, Siena, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Montagnani
keywords: Children; Management; Spinal epidural abscess; Staphylococcus aureus