Case 234: Neuropathic Spondyloarthropathy

Area of Science:

• Medical Case Study
• Radiology
• Infectious Disease

Background:

• A 70-year-old female presented with acute exacerbation of chronic obstructive pulmonary disease (COPD) and new-onset thoracolumbar back pain.
• Her medical history included stage 4 renal failure, type II diabetes, hypertension, and aortic stenosis.

Observation:

• The patient reported leg weakness, but had preserved perianal sensation and rectal tone.
• Pulmonary examination revealed wheezes and decreased basilar air entry. Laboratory tests showed an elevated erythrocyte sedimentation rate (ESR) of 56 mm/h.
• Chest radiographs indicated mild pulmonary edema and a small right pleural effusion.

Findings:

• Thoracic spine magnetic resonance (MR) imaging and computed tomography (CT) revealed a thoracic spine epidural abscess.
• The patient's renal insufficiency precluded the use of intravenous contrast agents for imaging.

Implications:

• This case underscores the critical need to consider spinal epidural abscesses in the differential diagnosis of back pain, especially in patients with risk factors.
• Prompt diagnosis and management are essential to prevent neurological complications and improve patient outcomes.