Sacral Dimple

A 5-month-old boy, the product of a normal, spontaneous, uncomplicated vaginal delivery, presented to a peripheral hospital with a 2-month history of recurrent fever, vomiting, seizures, and progressive lower limb weakness. He was discovered to have hydrocephalus secondary to a posterior fossa lesion. An external ventricular drain was inserted, and he was transferred to our hospital. Upon presentation, his head circumference was 45 cm (in the 90th percentile), pupils were equally reactive, and he was quadriparetic with the left side being weaker than the right. Spinal examination revealed a sacral dimple with purulent discharge on digital pressure. Magnetic resonance imaging revealed a brain abscess, a spinal dermoid cyst, and dermal sinus. He underwent craniotomy and abscess evacuation followed by untethering of the spinal cord, resection of the dermoid, and the skin sinus. He tolerated the procedure well, and his weakness improved. The antibiotic course was completed, and the external ventricular drain was removed. Follow-up after 2 years showed a normal neurologic examination.