Catastrophic chest pain: blinded by cardiopulmonary disease

Area of Science:

• Neurology
• Cardiology
• Infectious Disease

Background:

• A 53-year-old male with multiple comorbidities including diabetes, coronary artery disease, and hypertension presented with recurrent chest pain.
• The patient had recently undergone drug-eluting stent placement for right coronary artery stenosis.
• Non-compliance with antiplatelet medication (clopidogrel) raised concerns for in-stent thrombosis, though workup was negative.

Observation:

• The patient developed acute bilateral flaccid leg weakness, urinary retention, and sensory loss from the umbilicus downwards.
• Magnetic Resonance Imaging (MRI) revealed a T4-T6 epidural abscess.

Findings:

• Emergent decompression laminectomy and abscess drainage were performed.
• Post-operatively, the patient experienced rapid improvement in neurological deficits, with complete sensory recovery.
• Cultures identified Streptococcus sp., and the patient was treated with intravenous nafcillin for 8 weeks.

Implications:

• This case underscores the potential for serious neurological complications arising from spinal epidural abscesses.
• Prompt surgical decompression and appropriate antibiotic therapy are crucial for favorable neurological outcomes.
• Management requires a multidisciplinary approach, integrating neurosurgery, infectious disease, and rehabilitation.