TY - JOUR
T1 - Spinal epidural abscess with a rapid course in young healthy infantry recruits with multiple skin lacerations
AU - Honig, Asaf
AU - Or, Omer
AU - Barzilay, Yair
AU - Fraifeld, Shifra
AU - Pikkel, Yoav Y.
AU - Eliahou, Ruth
AU - Cohen, José E.
AU - Itshayek, Eyal
N1 - Publisher Copyright:
© 2016 Elsevier Ltd
PY - 2016/9/1
Y1 - 2016/9/1
N2 - In recent years, there has been high prevalence of Staphylococcus aureus (S. aureus) infection among soldiers in the Israeli military, with devastating sequelae in several cases. Emergency department physicians have developed a high level of suspicion for spinal epidural abscess (SEA) in patients presenting known risk factors; however, SEA is a particularly elusive diagnosis in young healthy adults with no history of drug abuse. We review three cases of SEA secondary to methicillin-sensitive S. aureus (MSSA) infection in young healthy soldiers without known risk factors. We retrospectively reviewed clinical files of soldiers treated at our Medical Center from 2004–2015 to identify patients diagnosed with SEA. Those aged less than 30 years with no history of intravenous drug use, spine surgery or spine trauma were included in the study. Three young army recruits met the inclusion criteria. These young men developed SEA through extension of MSSA infection to proximal skin and soft tissue from impetigo secondary to skin scratches sustained during “basic” training. All presented with mild nuchal rigidity and severe persistent unremitting lancinating radicular pain. Although healthy at baseline, they had a severe, rapidly progressive course. Following urgent surgery, two patients recovered after rehabilitation; one remained with paraparesis at late follow-up. Neurological deficits and systemic evidence of S. aureus infection progressed rapidly in these young healthy SEA patients with no history of drug abuse, emphasizing the critical role of timely MRI, diagnosis, and surgery.
AB - In recent years, there has been high prevalence of Staphylococcus aureus (S. aureus) infection among soldiers in the Israeli military, with devastating sequelae in several cases. Emergency department physicians have developed a high level of suspicion for spinal epidural abscess (SEA) in patients presenting known risk factors; however, SEA is a particularly elusive diagnosis in young healthy adults with no history of drug abuse. We review three cases of SEA secondary to methicillin-sensitive S. aureus (MSSA) infection in young healthy soldiers without known risk factors. We retrospectively reviewed clinical files of soldiers treated at our Medical Center from 2004–2015 to identify patients diagnosed with SEA. Those aged less than 30 years with no history of intravenous drug use, spine surgery or spine trauma were included in the study. Three young army recruits met the inclusion criteria. These young men developed SEA through extension of MSSA infection to proximal skin and soft tissue from impetigo secondary to skin scratches sustained during “basic” training. All presented with mild nuchal rigidity and severe persistent unremitting lancinating radicular pain. Although healthy at baseline, they had a severe, rapidly progressive course. Following urgent surgery, two patients recovered after rehabilitation; one remained with paraparesis at late follow-up. Neurological deficits and systemic evidence of S. aureus infection progressed rapidly in these young healthy SEA patients with no history of drug abuse, emphasizing the critical role of timely MRI, diagnosis, and surgery.
KW - Impetigo
KW - Radicular pain
KW - Skin lacerations
KW - Spinal epidural abscess
KW - Staphylococcus aureus infection
KW - Young infantry recruit
UR - http://www.scopus.com/inward/record.url?scp=84979662803&partnerID=8YFLogxK
U2 - 10.1016/j.jocn.2016.02.018
DO - 10.1016/j.jocn.2016.02.018
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C2 - 27364320
AN - SCOPUS:84979662803
SN - 0967-5868
VL - 31
SP - 127
EP - 132
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
ER -