1337. Spinal Intradural E. Coli Abscess Masquerading as a Neoplasm in a Pediatric Patient with History of Neonatal E. Coli Meningitis: a case report

Authors: Miri Kim, MD; Joshua Simon, MD; Kamran Mirza; Kevin Swong, MD; Stephen Johans, MD; Douglas Andersom, MD (Maywood, IL)

Introduction:
Spinal intradural mass lesions are an uncommon entity but are thoroughly documented in the neurosurgical literature, with almost all pathologic diagnoses returning as neoplastic in nature. Here we present a case report of a two-year old male who presented with bilateral lower extremity weakness and imaging findings initially concerning for syringomyelia in the setting of an intrinsic primary spinal cord lesion with finding of subdural abscess.

 Case:
A two-year old male with a past medical history of E. coli meningitis at the age of 2.5 months who presented with 1-2 week regression in ability to ambulate. MRI of the entire spine revealed dilatation of the central canal of the spinal cord beginning at T2 growing more prominent caudally, with a heterogeneous, multi-cystic, enhancing intramedullary mass extending from L3 to S1. The patient underwent T12-L5 laminectomies, tissue biopsy, and expansion duraplasty. Biopsy of the lesion showed spinal cord parenchyma with a robust inflammatory infiltrate with reactive gliosis. The infiltrate was comprised of a mixture of CD20+ B and CD3+ T cells.

Results:
Cultures from the operating room yielded pan-sensitive E. Coli and antibiotic therapy was initiated.  A repeat surveillance MRI was obtained one-month post-intervention with persistent enhancement of the inferior cystic lesion. Intracapsular material was sent for repeat cultures without positive growth.  At six-month follow up, he was ambulating well without noticeable deficits, no longer requiring his brace and meeting milestones appropriately. 

Conclusion:
In this patient, an incomplete treatment of a previous meningitis may have contributed to the formation of an indolent abscess within the subdural rather than epidural space. This patient benefited from surgical intervention as well as a prolonged course of antibiotics. With the resources available to aggressively rehabilitate the patient, there has been significant improvement in lower extremity functionality and overall patient status.