Bacterial meningitis and multiple abscess formation in the iliopsoas, erector spinae, and vastus lateralis muscle in a maintenance hemodialysis patient treated with continuous epidural anesthesia for herpes zoster-related pain control: A case report and review of the literature

Shunsuke Yamada, Narihito Tatsumoto, Noriko Nakamura, Kosuke Masutani, Toshiro Maeda, Takanari Kitazono, Kazuhiko Tsuruya

研究成果: Contribution to journalArticle

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Background: Infection is the second leading cause of mortality in patients who undergo maintenance hemodialysis. In this population, impairment in both cellular and humoral immunity contributes to the increased incidence of infection and infection-related hospitalization. However, these artificial devices occasionally enhance the risk of deep organ infection including muscle abscess, frequently leading to disability and mortality in hemodialysis patients. Case presentation: A 54-year-old male undergoing maintenance hemodialysis was hospitalized because of the acute onset pain in the back and bilateral legs and declining consciousness which started at 7 days after the treatment of herpes zoster-related neuralgia with continuous epidural anesthesia. Physical examination revealed purulent discharge from the insertion site of the catheter. Serum biochemical tests showed increased inflammatory response and malnutrition. Magnetic resonance imaging revealed meningitis and multiple abscesses in the iliopsoas, erector spinae, gluteus medius, and vastus lateralis muscles, where conventional antibiotic treatment often fails to cure. Staphylococcus aureus was detected in the cerebrospinal fluid. Combination of intravenous antibiotics treatment and aggressive open surgical drainage of the muscle abscesses finally cured meningitis and multiple deep muscle abscesses in this patient. Conclusions: Treatment with sensitive antibiotics and timely open surgical drainage is necessary to cure catheter-related meningitis and secondary deep muscle abscesses in hemodialysis patients. Our case also suggests that epidural anesthesia may not be a good therapeutic option for herpes zoster because patients with herpes zoster are immunologically more compromised during and shortly after reactivation of varicella zoster virus.

元の言語英語
記事番号22
ジャーナルRenal Replacement Therapy
4
発行部数1
DOI
出版物ステータス出版済み - 5 23 2018

All Science Journal Classification (ASJC) codes

  • Urology
  • Transplantation
  • Nephrology

フィンガープリント Bacterial meningitis and multiple abscess formation in the iliopsoas, erector spinae, and vastus lateralis muscle in a maintenance hemodialysis patient treated with continuous epidural anesthesia for herpes zoster-related pain control: A case report and review of the literature' の研究トピックを掘り下げます。これらはともに一意のフィンガープリントを構成します。

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