SHM Converge Scientific Abstract ePoster Gallery-A Hairy Story: Tale of a Late Spinal Dysraphism Diagnosis

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A 21-year-old woman developed recurrent urinary tract infections, urinary incontinence, and hypertension over three years, beginning after a cesarean delivery. She was admitted with acute pyelonephritis, positive urine culture for <em>Streptococcus agalactiae</em>, and acute-on-chronic renal failure. On physical examination, clinicians found a palpable right flank mass and a sacral patch of excessive hair (localized hypertrichosis), a key clue to an underlying congenital spinal abnormality.

Imaging with CT showed bilateral ureterohydronephrosis and diffuse bladder wall thickening, while MRI revealed sacral spina bifida occulta and tethered cord syndrome, with an associated lipoma in the spinal canal. The diagnosis was closed spinal dysraphism with tethered spinal cord, likely causing longstanding bladder dysfunction and contributing to chronic kidney disease.

She improved with antibiotic treatment (ceftriaxone followed by amoxicillin). Neurosurgery recommended conservative management for the tethered cord syndrome. Before discharge, she was taught clean intermittent catheterization and arranged for outpatient follow-up for chronic kidney disease and bladder dysfunction.

The case highlights that spina bifida occulta can be clinically silent for years but may present with cutaneous markers such as a hairy patch, dimple, hemangioma, lipoma, or dermal sinus tract. It can be associated with neurological deficits, urinary dysfunction, and renal complications. Tethered cord syndrome results from abnormal traction on the spinal cord and can worsen over time. The authors emphasize that a careful history and thorough physical examination may have identified the condition much earlier and potentially prevented complications.

Asset Subtitle

Lucas Gortz

Meta Tag

Author List Adriel Barbi Braz, Carolina Perrone Marques, Lucas Gortz, Mauricio Carvalho, Natalia Cunha

Category Clinical Vignettes

Concept Spina Bifida Occulta

Concept Tethered Cord Syndrome

Concept Closed Spinal Dysraphism

Concept Cutaneous Stigmata

Concept Urinary Dysfunction

Distinguished Non-Finalist

Presenter Organization Complexo Hospital De Clínicas - Universidade Federal Do Paraná (CHC-UFPR)

Presenting Author Lucas Gortz

Track Adult

Keywords

recurrent urinary tract infections

urinary incontinence

hypertension

acute pyelonephritis

Streptococcus agalactiae

spina bifida occulta

tethered cord syndrome

closed spinal dysraphism

ureterohydronephrosis

clean intermittent catheterization

Spina Bifida Occulta

Tethered Cord Syndrome

Closed Spinal Dysraphism

Cutaneous Stigmata

Urinary Dysfunction