Abstract
A 68-year old man had been suffering low back pain and a slight fever for two months. He also had hemorrhoid fistulae and used to puncture them using a needle. Pain on both lower extremities started one month later and he had occasional fever around 38 C. When he visited our hospital, he was slightly febrile (37.8 C) and drowsy. He also presented clinical symptoms of meningeal irritation, as well as pollakisuria and hyperreflexia of the patella and Achilles tendon reflex. Sensory disturbance distal to inguinal band was also seen. The Japan Orthopedic Association (JOA) score for lumbar lesion was 8/29. WBC was 12100/ml, CRP was 12.3mg/dl, and ESR was 71mm/1h in blood exams. MRI revealed a mass in isointesity on T1, high intensity on T2 posterior to the 5th vertebral body, suggesting subdural abscess. Emergency incision and drainage were performed. Surgery revealed adhesion between the cauda equina and arachnoid and cauda equina encased abscess. After irrigation and placement of the draining catheter, the wound was closed and antibiotics were administered.
Metithiline sensitive staphylococcus aureus was identified from the abscess. After drainage and administration of AB-PC, clinical symptoms and blood test values improved, except for the episode of high fever with skin rush due to allergy to AB-PC. At 10 months after surgery, his JOA score improved to 26/29 and the values of blood test values were within the normal range.
