[Vertebral osteomyelitis and epidural abscess after epidural anesthesia for a cesarean section]

A 40-year-old woman underwent cesarean section under epidural anesthesia. The anesthetic procedure was carried out in strict aseptic conditions, the catheter was withdrawn 24 hours after surgery, and the patient was discharged 5 days after surgery. She was readmitted with fever, backache, and pain in the lower limbs, with signs of radiculitis but no indication of inflammation or pain at the site of puncture. Magnetic resonance imaging revealed vertebral osteomyelitis at the fifth lumbar and first sacral vertebrae and an epidural abscess with compression of the nerve root. Treatment consisted of 2 g of ceftriaxone daily for 6 weeks, rest, and measures to assure local immobilization. Symptoms gradually improved and no surgical drainage measures were needed. The cause of osteomyelitis was never ascertained. Vertebral osteomyelitis is an unusual event after epidural anesthesia and there have been few opportunities to demonstrate a relationship. Such infections appear spontaneously in immunodepressed patients who undergo diagnostic procedures and treatments that lead to bacteremias with secondary colonization of spinal structures. The topography and characteristics of the infectious lesion, the patient's susceptibility, and the anesthetic procedure and pathogenic agent may help clarify the cause of the osteomyelitis.