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PEDIATRICS Vol. 109 No. 1 January 2002, pp. e14

ELECTRONIC ARTICLE

Group A Streptococcus Spinal Epidural Abscess During Varicella

Caroline Quach, MD, FRCPC*,{ddagger}, Bruce Tapiero, MD, FRCPC*, Francisco Noya, MD, FAAP{ddagger}

* Division of Infectious Disease, Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Quebec, Canada
{ddagger} Division of Infectious Disease, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada

or tapiero{at}cedep.net

--> Multiple complications of varicella have been described. Musculoskeletal complications (osteomyelitis, septic arthritis, and necrotizing fasciitis) as well as neurologic complications (ataxia, encephalitis, and transverse myelitis) are well-known. We describe the cases of 2 children, ages 18 months and 5 years, who were admitted recently to 2 pediatric hospitals in Montreal with a resolving varicella, abdominal and lumbar pain, and a refusal to walk and in whom a diagnosis of epidural abscess caused by group A streptococcus (GAS) was established. No previous case of epidural abscess caused by GAS in the context of varicella has been reported. Epidural abscesses are rare in pediatrics and are caused mainly by hematogenous spread of Staphylococcus aureus. The diagnosis in pediatrics is challenging because it is rare and does not present as classically as in adults. The prognosis is related to the presence of neurologic deficits before surgery and to the rapidity with which the diagnosis and the intervention are made. These cases highlight a new clinical association in children of epidural abscess caused by GAS and varicella. An early clinical diagnosis requires a high index of suspicion when back or abdominal pain with or without neurologic signs and symptoms occurs during or soon after varicella.

Key Words: varicella • spinal epidural abscess • group A streptococcus

Abbreviations: GAS, group A streptococcus • SEA, spinal epidural abscess • WBC, white blood cells • CSF, cerebrospinal fluid • MRI, magnetic resonance imaging • OR, operating room

Received for publication Jun 5, 2001; Accepted Aug 21, 2001.


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