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Case Report: Pseudomonas aeruginosa-related
Intervertebral Discitis in a Young Boy with Medulloblastoma
E. Mazza, F.
Spreafico, G. Cefalo, D. Scaramuzza, M. Massimino
Department
of Pediatric, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan,
Italy (E.M., F.S., G.C., M.M.); Department of Neuroradiology, Istituto Nazionale
per lo Studio e la Cura dei Tumori, Milan, Italy (D.S.)
We report a case of a 15-year-old boy with desmoplastic medulloblastoma
of the posterior fossa (T3M3, according to Chang classification) incompletely
resected, with leptomeningeal and nodular spread in the posterior fossa and in
the cervical and thoracic tracts of the spine, treated with sequential high dose
iv chemotherapy and with hyperfractionated cranio-spinal radiotherapy.
While on maintenance chemotherapy, the boy developed fever and septic status
caused by Pseudomonas aeruginosa, and 1 week later also low back
pain.
Magnetic resonance imaging (MRI) demonstrated abnormal signal in the fourth
ventricle and in the dorso-lumbar tract suggesting medulloblastoma recurrence,
so he started with a chemotherapy program.
Due to a worsening of back pain, a second MRI of the spine was performed that
showed a spondilodiscitis of T11-T12 and L1-L2 discs.
The histological and cultural examination of a fine-needle biopsy of the L1-L2
disc revealed the presence of P. aeruginosa.
So patient was treated with intensive antibiotic therapy with resolution of the
infection.
Spondilodiscitis is a rare complication in neoplastic patients, maybe due to
either immunodeficient status or invasive procedures such as lumbar
puncture.
This case demonstrates that MRI is a useful method for differentiating between
infection and malignancy in the spine, but sometimes it may be difficult to
distinguish metastatic tumor from a lesion due to spondilodiscitis.
In this case surgicopathological assessment is crucial and mandatory.
Keywords: medulloblastoma, Pseudomonas aeruginosa, spondilodiscitis
Copyright
©
2004 Kluwer Academic Publishers. All rights reserved
Source: http://ipsapp009.kluweronline.com/IPS/content/ext/x/J/5042/I/119/A/4/abstract.htm
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