Spinal epidural abscess due to tropical pyomyositis in immunocompetent adolescents

Report of 2 cases

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  • 1 Departments of Surgery,
  • 2 Radiology, and
  • 3 Infectious Disease, Tripler Army Medical Center, Honolulu, Hawaii;
  • 4 Department of Radiology and Radiological Sciences, Uniformed Services University of Health Sciences, Bethesda, Maryland; and
  • 5 Division of Neurosurgery, Connecticut Children's Medical Center, Hartford, Connecticut
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Pyomyositis, a suppurative infection of skeletal muscle, is a disease not frequently encountered by neurosurgical providers. While previously considered an infection localized to tropical and semitropical locations, clinical reports of pyomyositis in temperate climates have increased over the past decade. Paraspinal involvement is uncommon in pyomyositis; however, the potential exists for spread into the epidural space resulting in a spinal epidural abscess (SEA). Early diagnosis of an SEA is frequently hampered by the absence of specific signs, unfamiliarity with the disease, atypical manifestations, and a broad differential diagnosis that includes more common causes of back pain. To date, 1 such case of paraspinal pyomyositis associated with an SEA has been reported in the neurosurgical literature. The authors present 2 cases of pyomyositis with an SEA and review the epidemiology, pathophysiology, diagnostic workup, and management of this disorder.

Abbreviations used in this paper: MRSA = methicillin-resistant Staphylococcus aureus; PCP = primary care provider; SEA = spinal epidural abscess.

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Contributor Notes

Address correspondence to: Jonathan E. Martin, M.D., Department of Surgery, University of Connecticut School of Medicine, Connecticut Children's Medical Center, 282 Washington Street, Hartford, Connecticut 06106. email: jmartin03@ccmckids.org.
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