Diagnosis of spinal epidural abscess: a case report and literature review

Spinal epidural abscess (SEA) is a rare but serious cause of back pain in the critical care setting. It occurs most commonly in adults in their fifth and sixth decades of life. Risk factors include diabetes mellitus, alcoholism, AIDS or other immunocompromised states, cancer, intravenous drug use, trauma and spinal surgery. The clinical presentation can be non-specific but the classical triad includes back pain, fever and neurological deficits. Magnetic resonance imaging (MRI) with gadolinium is the diagnostic imaging modality of choice.

Here we report a case of SEA in a 63-year-old man with type II diabetes who presented with severe low back pain. He was found to have SEA likely secondary to a hip joint injection. The diagnosis was delayed due an earlier non-gadolinium-enhanced MRI of the spine showing no epidural abscess.

This case stresses the need for the definitive diagnostic study, MRI with gadolinium, in patients whose SEA is high on the list of differential diagnoses.