Para-spinal abscess presenting with abdominal pain-a case report of 'red herring' symptoms

Paraspinal abscesses are rare infections affecting the paraspinal muscles and soft tissues. An evolving abscess may pose a threat to the spinal cord via the compressive effect which can manifest as impaired motor or sensory function at the corresponding vertebral level. Paraspinal abscess is often a late diagnosis due to non-specific symptoms at presentation. This results in high morbidity and mortality.

We describe the case of a 59-year-old female with a paraspinal abscess presenting with epigastric pain who was initially worked up for a suspected intra-abdominal pathology, however computerised tomography of the chest, abdomen, and pelvis (CTCAP) revealed no abnormality. Later, rising inflammatory markers, accompanied by worsening cervicalgia, prompted a CT of the head, neck and thorax which revealed a soft tissue abscess compressing the thecal sac at cervical levels 1 to 3 (C1-3). This was successfully managed with radiologically guided drainage and long-term intravenous antibiotics. Our patient made a full recovery and a repeat MRI demonstrated resolution of the abscess.

We demonstrate that spinal abscess can present with a misleading combination of symptoms and highlight the importance of considering rarer differentials in the face of an evolving clinical picture. Our case also demonstrates that once the correct diagnosis is reached, patients can make an excellent recovery from uncomplicated spinal abscesses.