Perirectal abscess masquerading as cauda equina syndrome in an otherwise healthy 12-year-old child

A 12-year-old boy was brought to an urgent care center for fever, back pain, and abnormal gait. In addition to back pain, the patient was found to be persistently febrile but also had decreased perianal sensation and bowel incontinence. He was therefore referred to the emergency department where his back pain improved without medication but he was still febrile with bowel incontinence and persistently decreased perianal sensation. An MRI was ordered to evaluate possible cauda equina syndrome and revealed a perirectal abscess. The child ultimately underwent an exam under anesthesia with pediatric surgery and had a drain placed. This case highlights a unique presentation of perirectal abscess masquerading as cauda equina syndrome. A discussion of important considerations in emergency room diagnosis and management is presented.