Fatal Streptococcus melleri meningitis complicating missed infected intramedullary dermoid cyst secondary to dermal sinus in a Saudi child

• Published in: Journal of tropical pediatrics (1980) Vol. 59; no. 3; p. 246
• Main Authors: Bukhari, Elham Essa, Alotibi, Fawzia Eida
• Format: Journal Article
• Language: English
• Published: England 01.06.2013
• Subjects: Dermoid Cyst - complications; Dermoid Cyst - pathology; Fatal Outcome; Humans; Infant; Magnetic Resonance Imaging; Male; Meningitis, Bacterial - complications; Meningitis, Bacterial - diagnosis; Nose Diseases - complications; Nose Diseases - pathology; Spina Bifida Occulta - complications; Spina Bifida Occulta - pathology; Spinal Cord Diseases - complications; Spinal Cord Diseases - pathology; Streptococcal Infections - complications; Streptococcal Infections - diagnosis; Streptococcus - isolation & purification; Tomography, X-Ray Computed; Streptococcus melleri; dermal sinus; intramedullary abscess
• ISSN: 1465-3664
• DOI: 10.1093/tropej/fms073

A spinal intramedullary abscess secondary to an infected dermoid cyst is rare, and it has a poor prognosis, unless diagnosed and treated promptly. We report a 12-month-old patient with a spinal intramedullary abscess with secondary to a dermoid cyst resulting from a dermal sinus, despite a clearly defined opening at the lower back with discharge of a purulent material from a dermal sinus tract seen on the lower back before the patient had become symptomatic and showed meningeal signs. The patient was managed as a case of meningitis until he had complications that endangered his life, and then further radiological evaluation was done to delineate the underlying pathology. This case illustrates the importance of the recognition and evaluation of skin markers because of the potential for intradural extension and a frequent association with other dysraphic abnormalities. It also emphasizes the importance of early diagnosis and treatment of spinal intramedullary abscess.