Spinal Intradural Escherichia coli Abscess Masquerading as a Neoplasm in a Pediatric Patient with History of Neonatal E. coli Meningitis: A Case Report and Literature Review

• Published in: World neurosurgery Vol. 126; pp. 619 - 623
• Main Authors: Kim, Miri, Simon, Joshua, Mirza, Kamran, Swong, Kevin, Johans, Stephen, Riedy, Loren, Anderson, Douglas
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2019
• Subjects: Adrenal Cortex Hormones - therapeutic use; Anti-Bacterial Agents - therapeutic use; Combined Modality Therapy; Decompression, Surgical; Delayed Diagnosis; Diagnosis, Differential; Disease Progression; Drainage; Epidural Abscess - diagnosis; Epidural Abscess - drug therapy; Epidural Abscess - microbiology; Epidural Abscess - surgery; Escherichia coli; Escherichia coli Infections - diagnosis; Escherichia coli Infections - drug therapy; Escherichia coli Infections - surgery; Humans; Infant, Newborn; Intradural spinal abscess; Laminectomy; Magnetic Resonance Imaging; Meningitis; Meningitis, Escherichia coli - complications; Neuroimaging; Physical Therapy Modalities; Spinal Cord Compression - etiology; Spinal cord tumor; Spinal Neoplasms - diagnosis; Syringomyelia - diagnosis; Meningitis; Spinal cord tumor; Intradural spinal abscess; MRI; Escherichia coli
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.02.243

Central nervous system abscesses frequently can be seen in the immunocompromised population and most commonly consist of intracranial collections in the adult patient. Spinal intradural abscesses are less commonly encountered, and there are even fewer numbers in the pediatric population with a concordant absence of documentation in the published literature. In this case report, we describe the presentation of a 2-year-old boy with a history of perinatal Escherichia coli meningitis at 2.5 months of age who was found to have an intradural spinal lesion, initially concerning for neoplasm, but later confirmed as an E. coli abscess following biopsy. He was managed with surgical aspiration of the abscess and a long course of intravenous antibiotics. The patient was treated with antibiotics with repeat imaging studies that revealed residual abscess that required re-aspiration at a later date. Here we present an unusual disease process with an unusual disease pathogenesis in a pediatric patient currently residing in a developed country.