Diagnostic dilemma of sacral abscess presented with seizure and altered conscious level in a patient with spinal cord injury

The Journal of Spinal Cord Medicine, 2017 · DOI: 10.1080/10790268.2015.1133016 · Published: January 1, 2017

Simple Explanation

This case report highlights the risk of deep-seated abscesses in spinal cord injury (SCI) patients with chronic, non-healing pressure ulcers. These abscesses can be a hidden source of infection, leading to severe complications. The patient initially presented with a seizure and fluctuating consciousness, which complicated the diagnostic process. Standard investigations didn't immediately reveal the deep-seated sacral abscess. Even if a chronic ulcer appears clean, clinicians should suspect a deep abscess if a SCI patient shows signs of sepsis or altered mental state, particularly when treatment for other common infections isn't working.

Study Duration

Not specified

Participants

One 40-year-old male

Evidence Level

Level 4, Case Report

Key Findings

1
A deep-seated sacral abscess can present with unusual symptoms like seizures and altered consciousness in SCI patients.
2
Chronic, non-healing pressure ulcers in SCI patients can harbor deep-seated infections even if they appear clinically clean.
3
Radiological investigations like CT scans are crucial for diagnosing deep-seated abscesses in SCI patients with non-healing ulcers.

Research Summary

This case report describes a 40-year-old man with complete T4 SCI and multiple pressure ulcers who presented with seizure and altered conscious level, eventually diagnosed with a deep-seated sacral abscess. Initial investigations focused on common causes of infection like UTI, but the patient's fluctuating consciousness persisted. The sacral ulcer, despite appearing clean, harbored a deep abscess that was confirmed via CT scan. The case emphasizes the importance of considering deep-seated abscesses in SCI patients with chronic ulcers, even when the ulcers appear clean, and highlights the need for thorough radiological investigation when other infection sources are ruled out.

Practical Implications

Clinical Awareness

Raise awareness among clinicians about the atypical presentation of deep-seated abscesses in SCI patients, such as seizures and altered mental status.

Diagnostic Approach

Advocate for early and aggressive radiological investigations (CT or MRI) in SCI patients with chronic, non-healing ulcers when septicemia is suspected, even if the ulcer appears clean.

Wound Management

Emphasize the importance of preventing pressure ulcers and managing them aggressively to prevent chronic non-healing wounds that can lead to deep-seated infections and systemic complications.

Study Limitations

1
The patient refused lumbar puncture, preventing definitive confirmation of bacterial meningo-encephalitis.
2
The case report focuses on a single patient, limiting generalizability.
3
The exact timeline of abscess development prior to the acute presentation is unclear.

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