J Korean Soc Spine Surg.  2018 Mar;25(1):30-34. 10.4184/jkss.2018.25.1.30.

Widespread Lumbosacral Subdural Abscess after Bee Venom Therapy: A Case Report

• Choi JC
• Lee YS
• Eun DC
• Byun CW

• KMID: 2408305
• DOI: http://doi.org/10.4184/jkss.2018.25.1.30

Abstract

STUDY DESIGN: Case report.
OBJECTIVES
We report a case of widespread lumbosacral subdural abscess in a patient who underwent bee venom therapy. SUMMARY OF LITERATURE REVIEW: Subdural abscess is rare, but has a poor prognosis. Therefore, prompt recognition and appropriate treatment are paramount.
MATERIALS AND METHODS
A 54-year-old woman was hospitalized due to severe back pain. Two days previously, she had undergone bee venom therapy. The patient then visited the emergency room because of severe back pain. However, a paraspinal infection was not detected on enhanced magnetic resonance imaging (MRI). Six days after admission, the patient showed signs of meningeal irritation and an emergency cerebrospinal fluid analysis showed typical findings of bacterial meningitis. Although adequate antibiotic treatment was administered, 20 days after admission, the patient's symptoms became aggravated. Pachymeningeal enhancement, myelomeningitis, and subdural abscess compressing the cauda equina were found on enhanced MRI. Thus, laminectomy between L3-L4 and L5-S1 was performed, as well as subdural abscess drainage. Antibiotic agents were applied for 6 weeks after the operation, and resolution of the subdural abscess was identified on follow-up MRI.
RESULTS
In this patient, lumbosacral subdural abscess occurred due to bee venom therapy. It was cured by adequate surgical and antibiotic treatment.
CONCLUSIONS
Bee venom therapy can cause subdural abscess of the spinal cord. Even if it is a rare case, this possibility is worth consideration in the Korean medical context.

Keyword

Spine; Subdural abscess

MeSH Terms

Abscess*
Back Pain
Bee Venoms*
Bees*
Cauda Equina
Cerebrospinal Fluid
Drainage
Emergencies
Emergency Service, Hospital
Female
Follow-Up Studies
Humans
Laminectomy
Magnetic Resonance Imaging
Meningitis, Bacterial
Middle Aged
Prognosis
Spinal Cord
Spine
Bee Venoms

Figure

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  Fig. 1. At the first visit, a small amount of fluid collection was seen in the right L5-S1 facet joint on the T1-weighted contrast-enhanced view. (A) T1-weighted sagittal view, (B) T2-weighted sagittal view, (C, D) T1-weighted contrast-enhanced sagittal and axial views).

• 

  Fig. 2. Preoperative magnetic resonance imaging. Diffuse dural thickening and dural/pial enhancement from T8 to the sacral level were seen, suggesting spinal meningitis. These images also show clumping of the cauda equina with subdural fluid collection associated with a subdural abscess, from L2 to the sacral level. (A) T1-weighted sagittal view, (B, C) T1-weighted contrast-enhanced sagittal and axial views).

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  Fig. 3. After L3–L4 laminectomy, the thecal sac was opened and held with forceps, revealing the intradural purulent collection. The dural edges were held up with retention sutures. Pus was evacuated using copious irrigation assisted by a rubber catheter slid within the subdural space cranially and caudally.

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  Fig. 4. Postoperative magnetic resonance imaging. Sagittal and axial images obtained 6 weeks postoperatively demonstrate complete clearance of the subdural abscess, resolution of the mass effect on the thecal sac spinal cord, and tiny amounts of postoperative fluid collection at the laminectomy site (L3-L4 and L5-S1). (A) T1-weighted sagittal view, (B) T2-weighted sagittal view, (C, D) T1-weighted contrast-enhanced sagittal and axial views).

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