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Vol. 49, No. 2, 2013
Issue release date: March 2014

Congenital Dermal Sinus with an Infected Dermoid Cyst in the Cervico-Thoracic Spinal Cord

Lee B. · Jeelani Y. · McComb J.G.
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Abstract

Congenital dermal sinuses (CDS) are epithelium-lined tracts that result from incomplete separation of cutaneous ectoderm from the underlying neuroectoderm. CDS may be associated with dermoid cysts and can cause complications by mass effect and by functioning as a pathway for infection. Cervical and thoracic tracts are rare, making up 1 and 10% of all CDS, respectively. We present an unusual case of a cervico-thoracic CDS with concomitant infected dermoid leading to neurological dysfunction. A 1-year-old male with a normal developmental history presented with a several-week history of progressive weakness. Previous visits to two outside emergency departments diagnosed the patient with acute otitis media. After another episode of fever and worsening of neurological symptoms, the patient was correctly diagnosed as having CDS with an infected dermoid cyst. Antibiotics were initiated, the lesion was resected, and the patient improved neurologically. Although cervical and thoracic CDS with infected dermoids are rare, one should have a high index of suspicion when cutaneous stigmata of spinal dysraphism are identified. Due to the risk of neurological deterioration, the recommended treatment of CDS with or without a concomitant intraspinal dermoid is prompt administration of antibiotics and definitive surgical intervention. © 2013 S. Karger AG, Basel



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References

  1. Ackerman LL, Menezes AH: Spinal congenital dermal sinuses: a 30-year experience. Pediatrics 2003;112:641-647.

    External Resources

  2. Martinez-Lage JF, Esteban JA, Poza M, Casas C: Congenital dermal sinus associated with an abscessed intramedullary epidermoid cyst in a child: case report and review of the literature. Childs Nerv Syst 1995;11:301-305.
  3. Lee JK, Kim JH, Kim JS, Kim TS, Jung S, Kim SH, Kang SS, Lee JH: Cervical dermal sinus associated with dermoid cyst. Childs Nerv Syst 2001;17:491-493.
  4. Ackerman LL, Menezes AH, Follett KA: Cervical and thoracic dermal sinus tracts. A case series and review of the literature. Pediatr Neurosurg 2002;37:137-147.
  5. Gurbani SG, Cho CT, Lee KR: Staphylococcus epidermidis meningitis and an intraspinal abscess associated with a midthoracic dermal sinus tract. Clin Infect Dis 1994;19:1138-1140.
  6. Shen WC, Chiou TL, Lin TY: Dermal sinus with dermoid cyst in the upper cervical spine: case note. Neuroradiology 2000;42:51-53.
  7. Shah RK, Chaljub G, Swischuk LE: Lower cervical dermal sinus tract and associated intraspinal abscess causing meningitis in a child. Emerg Radiol 2003;10:160-162.


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