Intramedullary Thoracic Spinal Cord Abscess Mimicking an Intramedullary Tumor: A Case Report

An intramedullary abscess is an extremely rare form of infection of the spinal cord, with only about 100 cases reported in the literature. It typically presents with back pain, neurological deficits, and, occasionally, fever. The purpose of this article is to report a case of an intramedullary thoracic spinal cord abscess that was initially misdiagnosed as an intramedullary tumor. A 48-year-old female presented with chronic inter-scapular pain and lower limb weakness. The patient was initially misdiagnosed as a case of intramedullary spinal cord tumor, primarily due to the rarity of intramedullary spinal cord abscess (ISCA) as well as the absence of ring enhancement in the lesion on MRI. However, during a surgical procedure for the excision of the lesion, it was found to be a case of ISCA. The purulent contents of the lesion were evacuated, and the patient was treated with IV antibiotics, leaving the patient with a slight residual lower limb weakness on the follow-up examination. This case highlights the importance of considering intramedullary abscess as a possible diagnosis in patients with back pain and neurological deficits, even in the absence of ring enhancement on imaging. Prompt surgical intervention should be considered in probable cases of intramedullary spinal cord tumors.