Pneumorrhachis Secondary to an Infected Sacral Decubitus Ulcer

Abstract

Pneumorrhachis (PR) is a rare phenomenon, which consists in the presence of air in the spinal canal. There are various aetiologies, being the most common traumatic, non-traumatic and iatrogenic. The diagnosis is primarily done through radiographic findings and it is necessary to understand the mechanism behind its origin. PR secondary to decubitus ulcer (DU) infection is rare. PR is associated with great morbidity and mortality. In selected cases, surgical intervention may be necessary. A 67-year-old woman, dependent, was admitted to the emergency room (ER) and diagnosed with an infected sacral DU, later discharged with antibiotics. She was readmitted to the ER two weeks later, with prostration and fever. On examination, she scored five points on the Glasgow coma scale, had bilateral Babinsky sign and a deep sacral ulcer with bone exposure. A cranial computerized tomography (CT) demonstrated "high cervical and endochannel emphysema in the upper slope of the cervical segment" and the CT scan of the spine showed "endochannel air along the cervical-dorsal and lumbar rachis in an epidural location and inside the dural sac (evoking laceration of the dura mater) (…) and densification of the sacrococcygeal soft tissues (diagnosis of PR secondary to DU infection)". Broad-spectrum antibiotics were started and the patient was evaluated by General Surgery, which described a large sacral ulcer with signs of the previous debridement and bone exposure, with no indication for surgical debridement, only for chemical debridement. Despite all the measures instituted, the patient died in the ER.