Epidural empyema relating to dorsal myiasis

Pereira, Júlio Leonardo Barbosa; Carvalho, Gervásio Teles Cardoso de; Borgo, Mauro Cruz Machado

doi:10.1590/S0037-86822010000300028

IMAGES IN INFECTIOUS DISEASES

^ISanta Casa de Belo Horizonte, Belo Horizonte, MG

^IIFaculty of Medical Sciences of Minas Gerais, Belo Horizonte, MG

Address to

Epidural empyema is responsible for around one in every 20,000 hospital admissions and is an uncommon infectious entity. Immediate diagnosis is very important for early treatment, in order to diminish the morbidity. The patient was a previously healthy 22-year-old male who presented with a history of cutaneous lesions in the dorsal region. The initial medical evaluation led to removal of a larva, and a diagnosis of myiasis was made (Figure A). After 15 days, the patient developed pain in the dorsal region that radiated to the left anterior hemithorax, followed by rapidly progressive paraparesis and urinary and fecal incontinence, along with T8 dermatome sensory level. He was not feverish during this period, and a complete blood count showed leukocytosis with left shift, while PCR was high. An HIV serological test was negative, and the patient said that he had not been using any intravenous drugs. Magnetic resonance imaging (MRI) of the thoracic spine showed an image suggestive of epidural empyema, extending from T8 to T11 (Figures B and C), and the patient was then referred to our service. We performed T8-T11 hemilaminectomy, with drainage of the epidural empyema, and administered antibiotics. Blood culturing did not show growth of any microorganisms, while culturing of secretions yielded Staphylococcus aureus growth. After the operation, the patient's fecal and urinary incontinence improved, with partial recovery of sensitivity, although he remained paraparetic (grade 2/5). What was unusual in our case was that the starting point for the epidural empyema was myiasis in the dorsal region in a young and previously healthy patient. From these data, it can be concluded that epidural empyema remains a diagnostic and therapeutic challenge because of the nonspecific nature of the clinical and laboratory signs.

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