Epidural Lumbar Abscess With Unknown Route Of Sepsis
スポンサーリンク
概要
- 論文の詳細を見る
We treated a case of epidural lumbar abscess in whom the route of sepsis could not be identified. Epidural spinal abscess is extremely rare and often the subject of delayed diagnosis and treatment. A previously healthy 68-year-old man developed back pain one week earlier and was hospitalized with fever, back pain, right shoulder pain, confusion, hypotension, vomiting, and urinary incontinence. He reported bilateral paresthesia over the lateral aspect of his thighs. The skin on his upper chest, bilateral upper extremities, and hands bore a reddish hue. Laboratory examination revealed serum CRP of 33.4mg/dl and a white cell count of 24, 050/mm3. Our tentative diagnosis was sepsis, although its origin remained unknown. Lumbar CT and MRI showed multiple space-occupying lesions in the iliopsoas and paravertebral muscles and in the lumbar epidural space. S. aureus (MSSA) grew in blood culture and appropriate antibiotics and gamma globulin were administered as soon as possible after admission. On hospital day 3, his condition improved. On hospital day 5, however, he again developed severe back pain, fever, and weakness of both lower extremities. Lumbar CT showed expansion of the space-occupying lesions, so we surgically drained the abscesses in the iliopsoas muscles. The man's condition improved neurologically but worsened again on hospital day 10. On hospital day 12, we surgically drained the abscesses in the epidural lumbar space, removing purulent material, and conducted L1-L4 decompressive laminectomy. He eventually improved satisfactorily and was discharged in good general condition after 3 months of hospitalization. Although time elapsed before surgical treatment due to the difficulty of making a definitive diagnosis, we achieved a successful outcome without obvious sequelae with intensive antimicrobial therapy started early and surgical drainage of abscesses in the iliopsoas muscles, which ultimately prevented worsening of the epidural abscess.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
- Emergency Endovascular Repair for a Ruptured Abdominal Aortic Aneurysm Patient
- Degree of injury severity of the traffic accident autopsy cases.
- タイトル無し
- The Effect of Antithrombin III on Cytokine Production in Endotoxemic Rats.
- Antithrombin III Effects on the Production of Vasoactive Substances in Endotoxemic Rats.