Widespread Lumbosacral Subdural Abscess after Bee Venom Therapy - A Case Report -

Jun-Cheol Choi; Young-Sang Lee; Dong-Chan Eun; Chan-Woong Byun

doi:10.4184/jkss.2018.25.1.30

Journal List > J Korean Soc Spine Surg > v.25(1) > 1076168

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Choi, Lee, Eun, and Byun: Widespread Lumbosacral Subdural Abscess after Bee Venom Therapy - A Case Report -

Case Report

Journal of Korean Spine Surg 2018;25(1):30-34.

Published online: 31 March 2018

DOI: https://doi.org/10.4184/jkss.2018.25.1.30

Widespread Lumbosacral Subdural Abscess after Bee Venom Therapy - A Case Report -

Jun-Cheol Choi, M.D., Young-Sang Lee, M.D., Dong-Chan Eun, M.D., Chan-Woong Byun, M.D.

Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Seongnam, Korea

Corresponding author: Young-Sang Lee, M.D. Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, 180 Gil 20 Seohyun-ro, Bundang-gu, Seongnam 13590, Korea TEL: +82-31-779-0175, FAX: +82-31-779-0179 E-mail: yslee2808@gmail.com

Received 13 September 201727 September 2017 Accepted 2 February 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Case report.

Objectives

We report a case of widespread lumbosacral subdural abscess in a patient who underwent bee venom therapy.

Summary of Literature Review

Subdural abscess is rare, but has a poor prognosis. Therefore, prompt recognition and appropriate treatment are paramount.

Materials and Methods

A 54-year-old woman was hospitalized due to severe back pain. Two days previously, she had undergone bee venom therapy. The patient then visited the emergency room because of severe back pain. However, a paraspinal infection was not detected on enhanced magnetic resonance imaging (MRI). Six days after admission, the patient showed signs of meningeal irritation and an emergency cerebrospinal fluid analysis showed typical findings of bacterial meningitis. Although adequate antibiotic treatment was administered, 20 days after admission, the patient's symptoms became aggravated. Pachymeningeal enhancement, myelomeningitis, and subdural abscess compressing the cauda equina were found on enhanced MRI. Thus, laminectomy between L3-L4 and L5-S1 was performed, as well as subdural abscess drainage. Antibiotic agents were applied for 6 weeks after the operation, and resolution of the subdural abscess was identified on follow-up MRI.

Results

In this patient, lumbosacral subdural abscess occurred due to bee venom therapy. It was cured by adequate surgical and antibiotic treatment.

Conclusions

Bee venom therapy can cause subdural abscess of the spinal cord. Even if it is a rare case, this possibility is worth consideration in the Korean medical context.

Keywords: Spine, Subdural abscess

REFERENCES

1. Darouiche RO. Spinal epidural abscess and subdural empyema. Handb Clin Neurol. 2000; 96:91–9. DOI: 10.1016/s0072-9752 (09)96007-9.

2. Bluman EM, Palumbo MA, Lucas PR. Spinal epidural abscess in adults. J Am Acad Orthop Surg. 2004 May-Jun; 12(3):155–63. DOI: 10.5435/00124635-200405000-00003.

3. Bartels RH, de Jong TR, Grotenhuis JA. Spinal subdural abscess: Case report. J Neurosurg. 1992 Feb; 76(2):307–11. DOI: 10.3171/jns.1992.76.2.0307.

4. Levy ML, Weider BH, Schneider J, et al. Subdural empyema of the cervical spine: Clinicopathological correlates and magnetic resonance imaging: Report of three cases. J Neurosurg. 1993 Dec; 79(6):929–35. DOI: 10.3171/jns.1993.79.6.0929.

5. Chen CY, Lin KL, Wang HS, et al. Dermoid cyst with dermal sinus tract complicated with spinal subdural abscess. Pediatr Neurol. 1999 Feb; 20(2):157–60. DOI: 10.1016/s0887-8994 (98)00126-x.

6. Lim HY, Choi HJ, Kim SJ, et al. Chronic spinal subdural abscess mimicking an intradural–extramedullary tumor. Eur Spine J. 2013 May; 22(3 Suppl):497–500. DOI: 10.1007/s00586-013-2700-1.

7. Vural M, Arslantaş A, Adapinar B, et al. Spinal subdural Staphylococcus aureus abscess: case report and review of the literature. Acta Neurol Scand. 2005 Nov; 112(5):343–6. DOI: 10.1111/j.1600-0404.2005.00496.x.

8. Bluman EM, Palumbo MA, Lucas PR. Spinal epidural abscess in adults. J Am Acad Orthop Surg. 2004 May-Jun; 12(3):155–63. DOI: 10.5435/00124635-200405000-00003.

Fig. 1.

At the first visit, a small amount of fluid collection was seen in the right L5-S1 facet joint on the T1-weighted contrast-enhanced view. (A) T1-weighted sagittal view, (B) T2-weighted sagittal view, (C, D) T1-weighted contrast-enhanced sagittal and axial views).

Fig. 2.

Preoperative magnetic resonance imaging. Diffuse dural thickening and dural/pial enhancement from T8 to the sacral level were seen, suggesting spinal meningitis. These images also show clumping of the cauda equina with subdural fluid collection associated with a subdural abscess, from L2 to the sacral level. (A) T1-weighted sagittal view, (B, C) T1-weighted contrast-enhanced sagittal and axial views).

Fig. 3.

After L3–L4 laminectomy, the thecal sac was opened and held with forceps, revealing the intradural purulent collection. The dural edges were held up with retention sutures. Pus was evacuated using copious irrigation assisted by a rubber catheter slid within the subdural space cranially and caudally.

Fig. 4.

Postoperative magnetic resonance imaging. Sagittal and axial images obtained 6 weeks postoperatively demonstrate complete clearance of the subdural abscess, resolution of the mass effect on the thecal sac spinal cord, and tiny amounts of postoperative fluid collection at the laminectomy site (L3-L4 and L5-S1). (A) T1-weighted sagittal view, (B) T2-weighted sagittal view, (C, D) T1-weighted contrast-enhanced sagittal and axial views).

TOOLS

Similar articles