Introduction

Pyogenic spinal infections (PSI) are a rare cause of spinal cord injury (SCI). These most often affect the lumbar spine, followed by the thoracic spine and least commonly the cervical spine, with Staphylococcus aureus being the most common causative organism. Atopic eczema is a dermatological condition which can lead to a breakdown of the skin’s natural barrier function, allowing bacterial colonisation and infection. Haematological seeding of bacteria from a distant source of infection, including the skin and soft tissues, is a recognised aetiology of PSI.

Case presentation

We present two patients who sustained a SCI as a result of PSI secondary to infected atopic eczema. Methicillin-sensitive Staphylococcus aureus (MSSA) was identified as the causative organism in both patients. The two patients required prolonged courses of intravenous followed by oral antibiotics. Neurological outcomes varied between the two patients. One patient had incomplete tetraplegia (C3 AIS C), and upon discharge required hoisting from their bed to a power chair, had an indwelling urethral catheter and required bowel care. The other patient had incomplete paraplegia (L3 AIS D), and at discharge was independent with activities of daily living and was mobile with two elbow crutches.

Discussion

We believe that the two cases presented here represent the only examples of secondarily infected atopic eczema causing PSI and resultant SCI in the published literature. As SCI is a serious and potentially life-altering complication, medical professionals treating patients with atopic eczema should be aware of this risk.

中文翻译：

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金黄色葡萄球菌化脓性脊髓感染并发感染性特应性湿疹所致脊髓损伤：两例病例报告

介绍

化脓性脊柱感染（PSI）是脊髓损伤（SCI）的罕见原因。这些最常影响腰椎，其次是胸椎，最不常见的是颈椎，其中金黄色葡萄球菌是最常见的致病微生物。特应性湿疹是一种皮肤病，可能导致皮肤天然屏障功能破坏，导致细菌定植和感染。从远处感染源（包括皮肤和软组织）传播细菌的血液学播种是 PSI 的公认病因。

案例展示

我们介绍了两名因感染特应性湿疹继发 PSI 导致 SCI 的患者。两名患者的致病菌均被确定为甲氧西林敏感金黄色葡萄球菌（ MSSA）。这两名患者需要长时间静脉注射，然后口服抗生素。两名患者的神经学结果各不相同。一名患者患有不完全性四肢瘫痪（C3 AIS C），出院后需要从床上抬到电动椅上，留置导尿管并需要肠道护理。另一名患者患有不完全性截瘫（L3 AIS D），出院时能够独立进行日常生活活动，并且可以拄着两根肘拐活动。

讨论

我们相信，这里介绍的两个病例代表了已发表文献中继发感染特应性湿疹导致 PSI 和由此产生的 SCI 的唯一例子。由于 SCI 是一种严重且可能改变生命的并发症，治疗特应性湿疹患者的医疗专业人员应该意识到这种风险。