The Journal of the Arkansas Medical Society Med Journal April 2020 | Page 8

Case Study
by Jesse J. Xie, MD; 1 Natalie B. Peeples, MD; 1
Charles Ryan Humphries, MS; 2 Thaddeus Bartter, MD 3
1. Department of Internal Medicine, UAMS, Little Rock, Ark.
2. Graduate of University of Mississippi Medical Center, Jackson, Miss.
3. Division of Pulmonary and Critical Care, Department of Internal Medicine, Central Arkansas Veteran Heath Systems, Little Rock Ark.
A Rare Case of Temporalis Muscle Abscess Secondary
to Mayfield Clamp Pin Sites in a Post-Operative
Neurosurgery Patient
Abstract
to palpation at the surgical site or costovertebral
angle tenderness. Due to concern of perinephric
Introduction: Neurosurgical interventions are
abscess following his urinary tract infection, sep-
becoming more and more common in the U.S.
sis protocol was activated
Based on a study between 2006 and
on arrival and the patient
2013, there were 94,621 neurosur-
1
was started on vancomycin
gical surgeries performed. As with
and cefepime. Computed
any invasive procedure, post-opera-
tomography (CT) of abdo-
tive complications are a major con-
men/pelvis revealed blad-
cern. Uncommonly, the head-clamp
der wall thickening con-
device used to secure the head of the
sistent with cystitis but no
patient for surgery is a contributor of
fluid collections. CT neck
such complications and can easily
2
revealed
post-operative
be missed.
changes but no acute find-
ings concerning for infec-
Summary: Here we describe the
tion. The patient continued
case of a 50-year-old man who
to complain of bilateral jaw
was two weeks post-op from a C5-
pain, and magnetic reso-
C7 resection of an intradural mass
nance imaging (MRI) brain
when he presented with high-grade
was ordered and revealed
fevers that persisted despite broad
bilateral temporalis mus-
spectrum IV antibiotics. The source
cle fluid collections with
of his fevers was found to be tempo-
abnormal enhancement
ralis muscle abscesses at the sites of
and central fluid collec-
his Mayfield head clamps.
Figure 1: Bilateral temporalis muscle inflammation and abnormal enhancement with tions consistent with
abscesses (left greater
Conclusion: Abscess from head-se- central fluid concerning for abscess (left greater than right).
than right). Due to his re-
curing surgical clamps is a rare com-
plication, but should remain in the differential of a discharged from ED back to physical rehabilita- cent surgery and location of the abscesses, they
were determined to be secondary to surgical head
febrile post-op neurosurgery patient. This com- tion facility.
At the rehab facility, patient was noted to have clamps. Blood and urine cultures from admission
plication will require a more aggressive antibiotic
course or drainage to resolve, and could easily be recurrent febrile episodes and was eventually showed no growth. Given that he had already re-
missed in patients with numerous comorbidities. switched to ciprofloxacin. Despite appropriate ceived multiple days of antibiotics and improving
antibiotic therapy and resolution of dysuria, he clinically on broad spectrum antibiotics, wound
continued to have fevers up to 103 F and returned cultures were not obtained, as they were unlike-
Case
A 50-year-old African American male who was to the ED three days after initial evaluation. At that ly to yield positive growth and unlikely to change
recently found to have an intradural mass with time, the patient’s only complaint was bilateral therapy. Patient subsequently improved with a
subsequent resection and C5-C7 laminectomy jaw pain. Vital signs showed fever of 104 F and two-week course of vancomycin and cefepime
presented to emergency department (ED) two briefly hypotensive to 90s/60s, which normalized therapy.
weeks after his surgery with dysuria and fever of with half a liter of normal saline. His surgical site
101 degrees Fahrenheit. Initial workup showed was healing well without erythema, edema, in- Discussion
40 WBC, 3+ leukocyte esterase, 1+ bacteria on duration, or drainage. There was no tenderness Mayfield clamps are a three-prong positioning
224 • The Journal of the Arkansas Medical Society
urinalysis, and urine culture grew pan-sensitive
Klebsiella. He was given one dose of ceftriaxone,
started on cephalexin for outpatient therapy, and
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