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Holocord Spinal Epidural Abscess From Community-Acquired Methicillin-Resistant Staphylococcus aureus

Frantz, Megan MSIII*; Wang, Sheila MD; Abughali, Nazha MD

Infectious Diseases in Clinical Practice: January 2011 - Volume 19 - Issue 1 - p 61-63
doi: 10.1097/IPC.0b013e3181e978c0
Case Reports

Holocord spinal epidural abscess is extremely rare. We describe a child with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) holocord spinal epidural abscess, bacteremia, osteomyelitis, endocarditis, and intestinal pneumatosis. A 5-year-old boy presented with abdominal pain, fever, and limp. Computed tomography revealed pneumatosis intestinalis. He rapidly lost motor function in his legs. Magnetic resonance imaging demonstrated an abscess extending from the first cervical vertebra to the sacrum, and blood cultures were positive for CA-MRSA with the Panton-Valentine leukocidin toxin. Echocardiography revealed a bicuspid aortic valve with vegetations. He was managed surgically with laminectomies and a prolonged course of antibiotics. He was left with paraplegia. Spinal epidural abscess is a diagnostic challenge especially in children; emergence of CA-MRSA might increase its severity. To prevent the devastating outcome of this disease, a high index of suspicion with a careful neurologic examination is necessary, and immediate institution of proper antibiotic therapy to cover CA-MRSA, coupled with surgical intervention, is paramount.

From the *Case Western Reserve University School of Medicine and †MetroHealth Medical Center, Cleveland, OH.

Correspondence to: Nazha Abughali, MD, MetroHealth Medical Center, 2500 Metrohealth Dr, Cleveland, OH 44109. E-mail:

The authors have no funding or conflicts of interest to disclose.

© 2011 Lippincott Williams & Wilkins, Inc.