ABSCESO EPIDURAL ESPINAL Y PARAVERTEBRAL POR ESCHERICHIA COLI. REPORTE DE UN CASO Y REVISIÓN DE LA LITERATURA
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Rev. Méd. La Paz
Abstract
Se trata de una paciente femenina de 42 años que inicia dolor lumbar posterior a esfuerzo físico intenso, el mismo incrementa en el tiempo requiriendo asociar a analgésicos no esteroideos, opioides débiles como el tramadol con mala respuesta. Se realizan estudios de imagen una TAC de columna con fractura por avulsión el cuerpo posterior de L4; se asocia espasmos musculares en muslo derecho además de dolor, alzas térmicas cuantificadas en 38,5 ° C, aparición de lesión en línea media de columna la cual incrementa de volumen y se hace pulsátil eritematosa y con calor local. Se realiza resonancia magnética en la cual se observa colección en planos superficiales posteriores (paraespinosos), y otra colección que se dirige hacia canal medular a nivel de L4-L5, se procede a toma de hemocultivo e inicio de antibióticos con vancomicina y piperacilina tazobactam; se realiza la limpieza de colección vertebral, además de laminectomía descompresiva la cual es exitosa. Llega el cultivo el cual reporta Escherichia coli sensible a aminoglucósidos y carbapenémicos, por lo que se administró imipenem 500 mg EV cada 6 horas por tres semanas. Fue un caso de difícil diagnóstico, tras lumbalgia aguda de difícil manejo que incremento de intensidad y se asoció a otros síntomas sistémicos que hizo sospechar el diagnostico, además se aisla un germen poco frecuente (Escherichia coli) tuvo una evolución favorable son resolución del cuadro.
This is a 42-year-old female patient who starts with low back pain after significant physical exertion, the pain increases and worsens over time requiring weak opioids with bad response. Imaging studies were performed, a CT of the spine with a fracture by pulling out the posterior body of L4; and muscle spasms in the right thigh were associated with pain, thermal rises quantified at 38.5 °, appearance of a lesion in the midline of the spine which increased in volume and became pulsatile, erythematous and with local heat. Magnetic resonance imaging was performed, which showed right subarticular L4-L5 disc protrusion without radicular compromise and right subarticular disc protrusion of L5-S1 with ipsilateral radicular compromise, and other collection that goes to the spinal canal at L4-L5 level, so, we proceed with vancomycin and piperacillin tazobactam treatment. She was sent to the operating room for cleaning for vertebral collection, and decompressive laminectomy, which was successful. The culture was taken and reported Escherichia coli sensitive to carbapenemic aminoglycosides, so the respective antibiotic rotation to imipenem 500 mg ev every 6 hours was performed, this was maintained for 3 weeks. It was a case of difficult diagnosis, after acute low back pain that was dificult to manage, and which increased in intensity and was associated with other systemic symptoms that made us suspect the diagnosis. In addition to the isolation of rare germ, it had a favorable evolution without resolution of the chart.
This is a 42-year-old female patient who starts with low back pain after significant physical exertion, the pain increases and worsens over time requiring weak opioids with bad response. Imaging studies were performed, a CT of the spine with a fracture by pulling out the posterior body of L4; and muscle spasms in the right thigh were associated with pain, thermal rises quantified at 38.5 °, appearance of a lesion in the midline of the spine which increased in volume and became pulsatile, erythematous and with local heat. Magnetic resonance imaging was performed, which showed right subarticular L4-L5 disc protrusion without radicular compromise and right subarticular disc protrusion of L5-S1 with ipsilateral radicular compromise, and other collection that goes to the spinal canal at L4-L5 level, so, we proceed with vancomycin and piperacillin tazobactam treatment. She was sent to the operating room for cleaning for vertebral collection, and decompressive laminectomy, which was successful. The culture was taken and reported Escherichia coli sensitive to carbapenemic aminoglycosides, so the respective antibiotic rotation to imipenem 500 mg ev every 6 hours was performed, this was maintained for 3 weeks. It was a case of difficult diagnosis, after acute low back pain that was dificult to manage, and which increased in intensity and was associated with other systemic symptoms that made us suspect the diagnosis. In addition to the isolation of rare germ, it had a favorable evolution without resolution of the chart.
Description
Vol. 31, No. 2