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Cerecedo-Lopez CD, Bernstock JD, Dmytriw AA, Chen JA, Chalif JI, Gupta S, Driver J, Huang K, Stanley SE, Li JZ, Chi J, Lu Y. Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature. BMC Infect Dis 2022; 22:141. [PMID: 35144555 PMCID: PMC8830018 DOI: 10.1186/s12879-022-07099-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 01/27/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Intramedullary abscesses are rare infections of the spinal cord. Intramedullary abscesses often have a complex presentation, making a high index of suspicion essential for prompt diagnosis and management. CASE PRESENTATION We present two cases of intramedullary abscesses referred to and ultimately managed at our institution. Delayed diagnosis occurred in both instances due to the rarity of intramedullary abscesses and their propensity to mimic other pathologies. For both patients, prompt surgical management and the rapid institution of broad-spectrum antibiotics were critical in preventing further neurological decline. CONCLUSIONS Although rare, it is critical to consider intramedullary abscesses on the differential for any MRI lesions that are hyperintense on T2 and peripherally enhancing on T1 post-contrast sequences, as even short delays in treatment can lead to severe neurological damage.
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Affiliation(s)
- Christian D. Cerecedo-Lopez
- grid.38142.3c000000041936754XDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, 02120 MA USA
| | - Joshua D. Bernstock
- grid.38142.3c000000041936754XDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, 02120 MA USA
| | - Adam A. Dmytriw
- grid.38142.3c000000041936754XDepartment of Neuroradiology, Brigham and Women’s Hospital, Harvard Medical School, MA Boston, USA
| | - Jason A. Chen
- grid.38142.3c000000041936754XDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, 02120 MA USA
| | - Joshua I. Chalif
- grid.38142.3c000000041936754XDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, 02120 MA USA
| | - Saksham Gupta
- grid.38142.3c000000041936754XDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, 02120 MA USA
| | - Joseph Driver
- grid.38142.3c000000041936754XDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, 02120 MA USA
| | - Kevin Huang
- grid.38142.3c000000041936754XDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, 02120 MA USA
| | - Susan E. Stanley
- grid.38142.3c000000041936754XDepartment of Medicine, Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Jonathan Z. Li
- grid.38142.3c000000041936754XDepartment of Medicine, Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - John Chi
- grid.38142.3c000000041936754XDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, 02120 MA USA
| | - Yi Lu
- grid.38142.3c000000041936754XDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, 02120 MA USA
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Raffa PEAZ, Vencio RCC, Ponce ACC, Malamud BP, Vencio IC, Pacheco CC, Costa FD, Franceschini PR, Medeiros RTR, Aguiar PHP. Spinal intramedullary abscess due to Candida albicans in an immunocompetent patient: A rare case report. Surg Neurol Int 2021; 12:275. [PMID: 34221606 PMCID: PMC8247672 DOI: 10.25259/sni_435_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background: A spinal intramedullary abscess is a rare clinical entity in which patients classically present with a subacute myelopathy and progressive paraplegia, sensory deficits, and/or bowel and bladder dysfunction. We report the second case of spinal intramedullary abscess caused by Candida albicans to ever be published and the first case of its kind to be surgically managed. Case Description: A 44-year-old female presented with severe lumbar pain associated with paraparesis, incontinence, and paraplegia. She reported multiple hospital admissions and had a history of seizures, having already undergone treatment for neurotuberculosis and fungal infection of the central nervous system unsuccessfully. Nevertheless, no laboratory evidence of immunosuppression was identified on further investigation. Magnetic resonance imaging showed a D10-D11, well-circumscribed, intramedullary mass within the conus, which was hypointense on T1-weighted imaging and hyperintense on T2/STIR weighted. The patient underwent surgery for removal and biopsy of the lesion, which provided the diagnosis of an intramedullary abscess caused by C. albicans, a very rare condition with only one case reported in literature so far. Conclusion: C. albicans intramedullary abscess is a very rare clinical entity, especially in immunocompetent patients. We highlight C. albicans as an important etiology that must be considered in differential diagnosis. Critical evaluation of every case, early diagnosis, timely referral and surgical management of the abscess is essential to improve neurological outcome.
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Affiliation(s)
| | | | | | | | - Isabela Caiado Vencio
- Department of Medicine, School of Medicine of Pontifical Catholic University of São Paulo, Sorocaba, São Paulo, Brazil
| | | | | | - Paulo Roberto Franceschini
- Department of Neurology and Neurosurgery, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | | | - Paulo Henrique Pires Aguiar
- Department of Medicine, Division of Neurology, Catholic Pontifical University of São Paulo, Sorocaba, São Paulo, Brazil
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Xiao X, Li Q, Ju Y. Giant central nervous system tuberculoma in pediatric patients: surgical case series. Childs Nerv Syst 2021; 37:2935-2941. [PMID: 33675392 PMCID: PMC8423696 DOI: 10.1007/s00381-021-05091-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/09/2021] [Indexed: 02/05/2023]
Abstract
Central nervous system tuberculoma is rare and challenging situation. Clinical records of patients with pathologically proven tuberculoma were retrospectively reviewed. Clinical presentation, lesion location, radiological characteristics, perioperative and surgical management, and outcome is summarized and analyzed. Eight patients were included and there was one girl. Age ranged from 3 to 14 years with mean age 9.8 years. Clinical duration ranged from 20 days to 2 years, and 3 patients had previous lung tuberculosis with anti-TB treatment. The lesion was in cerebellum in 6 cases, including 1 involving basal ganglia and 1 involving thalamus. The lesion was in basal ganglia, thalamus, and third ventricle in 1 case, and in T12-L1 spinal cord in another. Cerebellar lesion was resected via paramedian suboccipital approach in 5 patients, basal ganglia lesion via trans-cortical frontal horn approach in 2 patients, and intra-spinal lesion via trans-laminar approach in 1 patient. Follow-up ranged from 10 to 24 months. Of the 8 patients, 6 returned to normal life. One patient had cerebellar lesion resected and the thalamic lesion reduced in size after anti-TB treatment. One patient died from TB spreading. Our data showed that most patients can be successfully treated by resection of the lesion. Low T2 signal, ring shaped enhancement and peripheral edema strongly suggest tuberculoma. Empirical anti-TB treatment should be initiated perioperatively.
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Affiliation(s)
- Xiao Xiao
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Qiang Li
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Yan Ju
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China.
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Qu LM, Wu D, Guo L, Yu JL. Paraplegia from spinal intramedullary tuberculosis: A case report. World J Clin Cases 2020; 8:6353-6357. [PMID: 33392317 PMCID: PMC7760432 DOI: 10.12998/wjcc.v8.i24.6353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/27/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) mostly attacks the lungs, and extrapulmonary TB involving the central nervous system is uncommon; among these cases, spinal intramedullary TB is even more rare. The clinical manifestations of spinal intramedullary TB are similar to those of intramedullary spinal cord tumors. Therefore, it is necessary to make a careful differential diagnosis of spinal intramedullary lesions to achieve the appropriate treatment and favorable prognosis. We report a rare case of a young male patient with paraplegia due to spinal intramedullary TB, which is uncommon and regrettable.
CASE SUMMARY A 23-year-old male presented with fever accompanied by nausea and vomiting lasting for 2 mo and was then diagnosed with tubercular meningitis. After anti-TB treatment, his symptoms were significantly improved. However, 2 mo after the diagnosis of tubercular meningitis, the patient felt numbness below the costal arch level, which lasted for 1 wk, and he paid no attention to this symptom. What followed was paraplegia and urine/fecal incontinence. Magnetic resonance imaging of the thoracic spine showed a ring-enhanced intramedullary cord lesion at T8-T9. Lesion exploration showed enlargement of the spinal cord at T8-T9, and the lesion could be observed by incision. The lesion was adhered to the peripheral tissue and was grayish-white and tough with a poor blood supply and a diameter of approximately 0.8 cm. The lesion was resected completely. The results of pathological examination by both hematoxylin-eosin staining and acid-fast bacilli staining confirmed TB, accompanied by acute and chronic suppurative inflammation and granulation tissue formation. The patient was instructed to continue anti-TB treatment after the operation, but he did not follow the medical advice. Follow-up continued for ten years, the patient had persistent paraplegia, the numbness disappeared and urine/fecal sensation recovered.
CONCLUSION Although TB is a kind of benign disease, some cases progress rapidly. Moreover, spinal intramedullary TB may seriously endanger quality of life and still needs timely diagnosis and proper treatment.
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Affiliation(s)
- Li-Mei Qu
- Department of Pathology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Di Wu
- Department of Pathology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Liang Guo
- Department of Pathology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Jin-Lu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Volpe-Chaves CE, Lacerda MLGG, Castilho SB, Fonseca SSO, Saad BAA, Franciscato C, Tibana TK, Nunes TF, Venturini J, de Oliveira SMDVL, Paniago AMM. Vertebral tuberculosis as a paradoxical reaction to the treatment of pulmonary and meningeal tuberculosis in an immunocompetent patient: A case report. Medicine (Baltimore) 2020; 99:e20012. [PMID: 32481268 PMCID: PMC7249907 DOI: 10.1097/md.0000000000020012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/05/2020] [Accepted: 03/26/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Paradoxical reaction in tuberculosis (TB) is defined as the reappearance of general symptoms, aggravation of pre-existing diseases, or appearance of new lesions despite adequate anti-TB therapy. It may result from the hyperactivity of the immune response, resulting in an intense inflammation. There are few cases of vertebral TB reported as paradoxical reaction, mainly among immunocompetents patients. PATIENT CONCERNS We describe a male immunocompetent patient with confirmed pulmonary and meningeal TB. He was readmitted after 60 days of adequate treatment, with vertebral TB and paravertebral abscess, despite clinical improvement of the other locations. We defined as an uncommon case of a paradoxical reaction, confirmed by nuclear magnetic resonance and molecular rapid test for TB. DIAGNOSIS Mycobacterium tuberculosis (MTB) was detected in cerebrospinal fluid by molecular rapid test (Gene Xpert MTB/ rifampicina method). Sputum research and culture were positive for the same agent. Lumbosacral spine nuclear magnetic resonance revealed bone destruction from T8 to T11, and a paravertebral collection was found. Gene Xpert MTB/rifampicina and culture were positive for M tuberculosis in the drained material of the paravertebral abscess. INTERVENTIONS The paravertebral abscess was drainage by tomography-guided. Treatment with 4 anti-TB drugs was extended for 60 days and 2 anti-TB drugs was maintained for 10 months. There was a complete clinical improvement. OUTCOME After draining the paravertebral abscess, the patient progressively improved and was discharged for outpatient follow-up. He was on antituberculous drugs for 1 year; subsequently, complete resolution of the infection was reported. CONCLUSION Paradoxical reaction may be a difficult diagnosis in immunocompetent patient. Vertebral TB as a paradoxical reaction is an uncommon presentation. Therapeutic failure or resistance to treatment should be ruled out to confirm the diagnosis of paradoxical reaction.
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Affiliation(s)
- Cláudia Elizabeth Volpe-Chaves
- Graduate Program in Infectious and Parasitic Diseases of Federal University of Mato Grosso do Sul
- Regional Hospital of Mato Grosso do Sul
- Maria Aparecida Pedrossian University Hospital
| | | | | | | | - Bruna Abdul Ahad Saad
- Graduate Program in Infectious and Parasitic Diseases of Federal University of Mato Grosso do Sul
- Regional Hospital of Mato Grosso do Sul
| | - Caroline Franciscato
- Graduate Program in Infectious and Parasitic Diseases of Federal University of Mato Grosso do Sul
- Maria Aparecida Pedrossian University Hospital
| | | | | | - James Venturini
- School of Medicine at Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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