Vertebral osteomyelitis with epidural abscess in a child with sickle cell disease.

A case of paraplegia due to a thoracic epidural abscess in a 6-year-old bla ck girl with sickle cell anemia is reported. MRI and CT scan showed abnorma lities involving T6 vertebra which were consistent with osteomyelitis. A la minotomy, associated to antibiotic administration, permitted rapid neurolog ical improvement. Although cultures were negative, the infection was probab ly due to salmonellae. Salmonellosis is a well-known complication in childr en with sickle cell disease but spinal localization is unusual. Its pathoge nesis is unclear but immunological abnormalities associated to vascular obs tructions by abnormal blood red cells have been advocated. The underlying e tiology of vertebral abnormalities in these children is difficult to determ ine, but early diagnosis with modern investigations, as CT scan and MRI, is crucial to promptly begin therapy for osteomyelitis, minimizing the risk o f spinal cord compression.