Article in Japanese

Three cases of congenital dermal sinus tract infection detected by prolonged fever

Midori ARAI¹⁾, Yoshiaki CHO²⁾, Yuichi OGAWA¹⁾, Kotaro ARAKI²⁾, Yuta AIZAWA²⁾, Hiroshi HATAYA¹⁾, Yuho HORIKOSHI²⁾

The incidence of dermal sinus tract (DST) was reported as 1 in 2,500 live births. Central nervous system infection including meningitis could be the first recognizable sign in 60% of cases. Early diagnosis of DST is critical in order to avoid devastating neurological infections, which could cause paralysis of the lower limbs, bladder dysfunction and severe constipation. However, the diagnosis is often delayed, because the abnormal skin manifestations in DST are not always evident or recognizable. This study experienced three DST cases presenting with persistent or relapsing fever. The time from initial presentation to DST diagnosis among these cases was 29, 32 and 127 days, respectively. As their skin manifestations were only slightly abnormal or covered with hair, early diagnosis was challenging. All of the cases required surgical resection of DST. DST should be considered for the differential diagnosis of persistent or relapsing fever without known focus in childhood. Careful physical examination of skin sites at the middle axis of the back could enable early detection of DST. Imaging studies should be performed in suspected cases, even in those with minor skin manifestation, in order to avoid neurological complication. There is no current consensus on the management of infected DST, as when to proceed to surgical resection during antimicrobial therapy. However, both early medical and surgical treatment are essential for avoiding neurological complication.

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1) Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center
2) Division ofInfectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center

Key words	dermal sinus tract, prolonged fever, dimple, spinal cord abscess
Received	November 27, 2017
Accepted	April 24, 2018

30 (2)：145─151,2018