1109 - Undiagnosed Dermal Sinus Tract Leading to Flaccid Triplegia in a Fourteen-Month-Old: A Case Report

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

mg

mackenzie gillund, DO

Resident physician
Atrium Health - Carolinas Rehabilitation
Charlotte, North Carolina, United States

Co-Author(s)

TY

Theodore Yip, MD

Pediatric Physiatrist
University of North Carolina Chapel Hill
Chapel Hill, North Carolina, United States
TT

Tobias J. Tsai, MD

Medical Director, Pediatric Rehabilitation
Carolinas Rehabilitation/Atrium Health Levine Children's Hospital
Charlotte, North Carolina, United States

Case Diagnosis: Holocord intramedullary lesion secondary to infected dermoid cyst

Case Description: A 14-month-old female with history of recurrent meningitis complicated by communicating hydrocephalus status post ventriculoperitoneal shunt placement presented with fever, irritability and altered mental status. She was started on broad-spectrum antibiotics on admission. She subsequently developed acute flaccid weakness with loss of sensation in both legs and right arm and acute urinary retention. Magnetic resonance imaging revealed diffuse thickening of spinal cord with holocord intramedullary lesion, closed dermal sinus tract and infected dermoid cyst. She underwent lumbar laminoplasty for cyst removal and was treated with intravenous antibiotics for twelve weeks. Repeat imaging showed marked improvement although persistent intramedullary signal abnormalities with decreasing evidence of meningitis. She was admitted to inpatient rehabilitation and at two-month follow up, she was noted to be rolling independently, using right hand for grasping objects, bearing weight through right arm, and starting to stand. At five-month follow-up, she started to take steps with assistance.

Discussions: Dermal sinuses are epithelial-lined tracts that extend from the skin surface to the spinal fascia, dura mater or spinal cord anywhere along the midline of the neural axis. If undiagnosed, they can lead to meningitis and p</span>rogressive neurological deficits. Associated holocord intramedullary lesions, as in this patient, have rarely been reported, but even when seen, functional recovery is possible with appropriate medical and surgical treatment and rehabilitation.

Conclusions: It is important to consider dermal sinus tracts in children with unexplained meningitis or neurologic deficits. Holocord intramedullary lesions are a rare associated finding. Medical and surgical management, with rehabilitation, can optimize function.