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KMID : 0378019750180101314
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New Medical Journal
1975 Volume.18 No. 10 p.1314 ~ p.1317
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A Case of Bacillus Subtilis Meningitis simulating Spinal Epidural Abscess
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Abstract
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A 26-year-old male patient was admitted to the Department of Neurosurgery, Capital Armed Forces General Hospital on July 4, 1974. He complained of severe headache, dizziness, vomiting and weakness of both lower extremities. Initially, 5 days previous to admission, weakness of right lower extremity was occurred and then it was aggravated progressively to result in paraplegia and urinary and fecal difficulty. On examination, he was mentally clear, well-oriented and speech was good. But his appearance was acutely illed and irritable. There was severe degree of stiffness of the neck and Kernig´s sign. Paraplegia was more on the right side with sensory loss below T10 level bilaterally in all sensory modalities. There was severe tenderness around T7 area on the back. Flaccid neurogenic bladder was present. DTRs were abolished in all part and Babinski and ankle clonus persisted. Blood count revealed moderate leucocytosis and mild degree of anemia which was aggravated progressively until the time of death. Urine was bloody and albuminuric. CSF study showed markedly elevated protein and pleocytosis. Blood culture gave gram-positive, straight rod arranged in long chain bearing spores in nearer one pole. Lumbar and cisternal myelography showed complete block of dye column Ll and C6 respectively. Total laminectomy was done under the diagnosis of the thoracic spinal epidural abscess, T7 area. We found severe arachnoid adhesions from Ll to T3.
Postoperatively neurological condition was much improved but systemic symptoms and signs were not calmed down in spite of massive antibiotic therapy. Patient died of fulminating bacteremia on August 11, 1974.
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