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Unusual case of spinal subdural empyema with ventriculitis managed conservatively with lumbar drain
  1. Catherine Wassef,
  2. Angelique Johnson and
  3. Jonathan Stone
  1. Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
  1. Correspondence to Dr Catherine Wassef; catherine_wassef{at}urmc.rochester.edu

Abstract

It has long been believed that spinal subdural empyemas (SDEs) with neurological symptoms result in death if operative intervention is not performed. We present a case of addressing an extensive spinal SDE with a minimally invasive procedure: a bedside lumbar drain. Our patient is a 67-year-old man with medical history significant for type I diabetes who presented 2 weeks after a right shoulder steroid injection with septic arthritis. An MRI was obtained for back pain which revealed spinal SDE from the cervical to lumbosacral spine. Given patient’s acute sepsis, haemodynamic instability, and extent of empyema, we placed a lumbar drain for decompression. The patient had a prolonged complicated hospital course. Imaging 2 months later revealed interval decrease in the spinal SDE. Although this severe septic event left the patient with significant deficits, he was able to return to ambulation without surgical intervention.

  • empyema
  • diabetes
  • bone and joint infections
  • meningitis
  • infection (neurology)

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Footnotes

  • Contributors CW has contributed to the idea, research, writing and editing of this manuscript and images. JS and AJ have contributed to the editing of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.