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Spontaneous Multiloculated Lumbar Abscess in a Middle-Aged Male With Unexplained Progressive Back Pain and Muscle
Mary Ann Nyc1, La'Kesha Francis2, Jason R Woloski3
1Family Medicine, University of California, Riverside, Riverside, USA.
Cureus
|September 1, 2022
Summary
A patient with severe back pain and weakness was diagnosed with a large thoracolumbar epidural abscess. Surgical drainage and antibiotics led to a good recovery, resolving most symptoms.
Area of Science:
- Neurosurgery
- Infectious Disease
- Radiology
Background:
- A 54-year-old male presented with a two-month history of progressive back pain and muscle weakness.
- Past medical history included sciatica and multiple orthopedic surgeries with hardware.
Observation:
- Magnetic Resonance Imaging (MRI) revealed abnormal enhancement from T11 to the sacrum.
- A large, complex, loculated epidural abscess was identified from L5 to the sacrum.
Findings:
- Neurosurgery performed a left L3-S1 unilateral laminotomy and evacuated the compressive epidural abscesses.
- Empirical antibiotic coverage with vancomycin and ceftriaxone was initiated.
- Wound cultures identified methicillin-susceptible Staphylococcus aureus (MSSA), leading to targeted therapy with cefazolin.
- The patient completed a six-week course of antibiotic therapy.
Implications:
- Successful surgical intervention and appropriate antibiotic treatment can lead to favorable outcomes in complex epidural abscess cases.
- Prompt diagnosis via MRI is crucial for effective management of spinal epidural abscesses.
- MSSA is a common pathogen in spinal epidural abscesses, necessitating targeted antibiotic selection based on culture results.
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