Abstract
Medical conditions predisposing to epidural abscess include diabetes, intravenous drug use, alcoholism, and other immunocompromised states. Although cirrhosis is associated with an increased risk of infection in general it has not previously been identified as a condition predisposing to epidural abscess. We describe two cirrhotic patients with spinal epidural abscesses. We speculate that the underlying immune defects associated with cirrhosis increase the risk of spontaneous epidural abscess and should raise concern for this infection when cirrhotic patients present with fever and back pain.
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References
References 1. Mackenzie AR, Laing RB, Smith CC, Kaar GF, Smith FW. Spinal epidural abscess: The importance of early diagnosis and treatment. J Neurol Neurosurg Psychiatry 1998; 65: 209–212.MackenzieAR]]LaingRB]]SmithCC]]KaarGF]]SmithFWSpinal epidural abscess: The importance of early diagnosis and treatmentJ Neurol Neurosurg Psychiatry199865209 2. Hoppe B. Spinal epidural abscess: The nurse's role in early detection and intervention. Heart Lung 1996; 25: 463–466.HoppeBSpinal epidural abscess: The nurse's role in early detection and interventionHeart Lung199625463 3. Hlavin ML, Kaminski HJ, Ross JS, Ganz E. Spinal epidural abscess: A ten-year perspective. Neurosurgery 1990; 27: 177–184.HlavinML]]KaminskiHJ]]RossJS]]GanzESpinal epidural abscess: A ten-year perspectiveNeurosurgery199027177 4. Navasa M, Rimola A, Rodes J. Bacterial infections in liver disease. Semin Liver Dis 1997; 17: 323–333.NavasaM]]RimolaA]]RodesJBacterial infections in liver diseaseSemin Liver Dis199717323 5. Kuo CH, Changchien CS, Yang CY, Sheen IS, Liaw YF. Bacteremia in patients with cirrhosis of the liver. Liver 1991; 11: 334–339.KuoCH]]ChangchienCS]]YangCY]]SheenIS]]LiawYFBacteremia in patients with cirrhosis of the liverLiver199111334 6. Morencos FC, de las Heras Castano G, Martin Ramos L, Lopez Arias MJ, Ledesma F, Pons Romero F. Small bowel bacterial overgrowth in patients with alcoholic cirrhosis. Dig Dis Sci 1995; 40: 1252–1256.MorencosFC]]de las Heras CastanoG]]Martin RamosL]]Lopez AriasMJ]]LedesmaF]]Pons RomeroFSmall bowel bacterial overgrowth in patients with alcoholic cirrhosisDig Dis Sci1995401252 7. Yang CY, Chang CS, Chen GH. Small-intestinal bacterial overgrowth in patients with liver cirrhosis, diagnosed with glucose H2 or CH4 breath tests. Scand J Gastroenterol 1998; 33: 867–871.YangCY]]ChangCS]]ChenGHSmall-intestinal bacterial overgrowth in patients with liver cirrhosis, diagnosed with glucose H2 or CH4 breath testsScand J Gastroenterol199833867 8. Runyon BA, Squier S, Borzio M. Translocation of gut bacteria in rats with cirrhosis to mesenteric lymph nodes partially explains the pathogenesis of spontaneous bacterial peritonitis. J Hepatol 1994; 21: 792–796.RunyonBA]]SquierS]]BorzioMTranslocation of gut bacteria in rats with cirrhosis to mesenteric lymph nodes partially explains the pathogenesis of spontaneous bacterial peritonitisJ Hepatol199421792 9. Llovet JM, Bartoli R, Planas R, Cabre E, Jimenez M, Urban A, et al. Bacterial translocation in cirrhotic rats: Its role in the development of spontaneous bacterial peritonitis. Gut 1994; 35: 1648–1652.LlovetJM]]BartoliR]]PlanasR]]CabreE]]JimenezM]]UrbanABacterial translocation in cirrhotic rats: Its role in the development of spontaneous bacterial peritonitisGut1994351648 10. Sorell WT, Quigley EM, Jin G, Johnson TJ, Rikkers LF. Bacterial translocation in the portal-hypertensive rat: Studies in basal conditions and on exposure to hemorrhagic shock. Gastroenterology 1993; 104: 1722–1726.SorellWT]]QuigleyEM]]JinG]]JohnsonTJ]]RikkersLFBacterial translocation in the portal-hypertensive rat: Studies in basal conditions and on exposure to hemorrhagic shockGastroenterology19931041722 11. Garcia-Tsao G, Lee FY, Barden GE, Cartun R, West AB. Bacterial translocation to mesenteric lymph nodes is increased in cirrhotic rats with ascites. Gastroenterology 1995; 108: 1835–1841.Garcia-TsaoG]]LeeFY]]BardenGE]]CartunR]]WestABBacterial translocation to mesenteric lymph nodes is increased in cirrhotic rats with ascitesGastroenterology19951081835 12. Rimola A, Soto R, Bory F, Arroyo V, Piera C, Rodes J. Reticuloendothelial system phagocytic activity in cirrhosis and its relation to bacterial infections and prognosis. Hepatology 1984; 4: 53–58.RimolaA]]SotoR]]BoryF]]ArroyoV]]PieraC]]RodesJReticuloendothelial system phagocytic activity in cirrhosis and its relation to bacterial infections and prognosisHepatology1984453 13. Gomez F, Ruiz P, Schreiber AD. Impaired function of macrophage Fc &ggr; receptors and bacterial infection in alcoholic cirrhosis. N Engl J Med 1994; 331: 1122–1128.GomezF]]RuizP]]SchreiberADImpaired function of macrophage Fc &ggr; receptors and bacterial infection in alcoholic cirrhosisN Engl J Med19943311122 14. Mellencamp MA, Preheim LC. Pneumococcal pneumonia in a rat model of cirrhosis: Effects of cirrhosis on pulmonary defense mechanisms against Streptococcus pneumoniae. J Infect Dis 1991; 163: 102–108.MellencampMA]]PreheimLCPneumococcal pneumonia in a rat model of cirrhosis: Effects of cirrhosis on pulmonary defense mechanisms against Streptococcus pneumoniaeJ Infect Dis1991163102