Cervical, Thoracic, and Lumbar Spine Epidural Abscess: Case Report and Literature Review
Bohdan Baralo1, Mrunal Kulkarni1, Rithikaa Ellangovan1
1Internal Medicine, Mercy Catholic Medical Center, Darby, PA, USA.
Case Reports in Infectious Diseases
|October 26, 2020
Summary
Spinal epidural abscess (SEA) can occur without typical risk factors. Early MRI and antibiotic treatment based on culture sensitivity are crucial for successful outcomes, especially in patients without neurological deficits.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Spinal epidural abscess (SEA) is a rare but serious condition.
- The incidence of SEA has been increasing over the last two decades.
- Typical symptoms are present in only 13% of cases, leading to delayed diagnosis.
Observation:
- A patient without significant risk factors presented with worsening back pain, sepsis, and suspected SEA.
- MRI revealed an extensive epidural abscess from the cervical to lumbar spine, with associated paraspinal abscesses.
- Needle aspiration provided cultures for targeted antibiotic sensitivity testing.
Findings:
- The patient was successfully treated with antibiotics guided by culture sensitivity.
- Early diagnosis and treatment are critical for favorable outcomes.
- Patients without neurological symptoms or with symptoms <36 hours have the best recovery.
Implications:
- Physicians should maintain a low threshold for ordering MRI in patients with new or changed back pain.
- CT-guided aspiration for cultures aids in conservative antibiotic management.
- Prompt diagnosis and treatment can prevent severe neurological complications associated with SEA.
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