Figure 1. Edema of the posterior paraspinal muscles is shown on axial T2-weighted image.
Figure 2. Enhancement of the posterior paraspinal muscles is seen on axial computed tomographic scan following intravenous contrast administration.
Figure 3. An epidural abscess with inflammatory change extending into the posterior paraspinal muscles is shown on sagittal (top) and axial (bottom) T1-weighted magnetic resonance images of the lumbar spine following intravenous gadolinium administration.
A repeated lumbar MRI (Figure 3) showed a large epidural abscess with erosion into the paraspinal muscles. The child was transferred to a tertiary care hospital for surgical drainage and has completely recovered. Staphylococcus aureus was grown from a culture specimen obtained directly from the abscess.
Spinal epidural abscess is rare in childhood. In this case, findings from the initial MRI and computed tomographic scan were confusing as the pus decompressed into the paraspinal muscles, resulting in a secondary pyomyositis. Rubin et al1 reviewed spinal epidural abscess in 1993, and they note that childhood spinal epidural abscess is usually of hematogenous origin, and S aureus is the usual etiologic agent (79% of all cases). It is seen more often in patients younger than 2 years or older than 12 years. The symptoms differ according to age. In a child younger than 2 years, neurological compromise at presentation is common. Older children often are seen for back pain and fever, although abdominal and hip pain are also presenting signs. The outcome correlates with the presence or absence of neurological signs at presentation. The definitive treatment is surgical drainage and antibiotic administration.
Obtaining an MRI is the diagnostic method of choice, although negative findings from MRI cannot exclude spinal epidural abscess.2 Most false-negative MRI findings seem to be secondary to motion artifact or adjacent similar-signal intensity from coexistent meningitis. To my knowledge, drainage into adjacent muscle groups, as in this case, has not been described in the literature.
Accepted for publication October 20, 1998.
Corresponding author: Don Seidman, MD, Elmhurst Pediatrics of the DuPage Medical Group, 103 Haven Rd, Elmhurst, IL 60126.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Pediatrics editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.