背景:硬膜外注射后皮下和硬膜外脓肿是一种严重但罕见的并发症。硬膜外脓肿通常由金黄色葡萄球菌细菌感染引起。在这里介绍的这种情况下,致病菌为粪肠球菌。
方法:一名67岁女性,患有慢性下背部和右腿疼痛,既往有20年类风湿关节炎病史,糖尿病,和骨质疏松症(T评分:-2.7)访问了门诊疼痛诊所。磁共振成像(MRI)显示L4-5右中央椎间盘突出,并有较低的迁移。我们进行了连续硬膜外阻滞7天,无并发症。10天后,她的腰痛加重,下背部红斑皮肤改变,令人不寒而栗,血清急性期反应物升高。
方法:随后通过MRI证实诊断,提示皮下和硬膜外脓肿。血液和脓液培养显示粪肠球菌生长。
方法:进行猪尾置管引流,并应用针对粪肠球菌的静脉抗生素(氨苄西林-舒巴坦),持续3周。出院后口服抗生素(阿莫西林/克拉维酸钾)6周。
结果:在2个月的随访中,观察到临床状况和血清急性期反应物水平均有改善.
结论:硬膜外注射可导致皮下脓肿进一步扩展到硬膜外腔。关键因素之一是共存条件的存在,包括糖尿病和长期使用类固醇由于类风湿性关节炎。
BACKGROUND: Subcutaneous and epidural abscesses following epidural injection are a serious but rare complication. Epidural abscesses are typically caused by Staphylococcus aureus bacterial infection. In this
case presented here, the causative bacterium was Enterococcus faecalis.
METHODS: A 67-year-old woman having chronic lower back and right leg pain with past history of 20 years of rheumatoid arthritis, diabetes mellitus, and osteoporosis (T-score: -2.7) visited the outpatient pain clinic. Magnetic resonance imaging (MRI) revealed L4-5 right central disc extrusion with inferior migration. We performed a continuous epidural block for 7 days without complications. After 10 days, she presented with worsened low back pain, erythematous skin change on the lower back, chilling, and elevated serum acute phase reactants.
METHODS: The diagnosis was subsequently confirmed by MRI suggesting subcutaneous and epidural abscess. Blood and pus cultures showed the growth of E. faecalis.
METHODS: Pigtail catheter drainage was performed and intravenous antibiotics (ampicillin-sulbactam) targeting E. faecalis were applied for 3 weeks. Oral antibiotics (amoxicillin/potassium clavulanate) were applied for 6 weeks after discharge.
RESULTS: At the 2-month follow-up, improvement in both the clinical condition and serum acute phase reactants levels were noted.
CONCLUSIONS: Epidural injection can lead to a subcutaneous abscess that is further extended into the epidural space. One of the key factors is the presence of comorbid conditions, including diabetes mellitus and prolonged steroid usage due to rheumatoid arthritis.