Streptococcus pneumoniae Spinal Epidural Abscess in an Immunocompetent Patient

Epidural abscesses are a rare diagnosis in immunocompetent patients. The most common risk factors linked with spinal epidural abscesses are intravenous drug use, diabetes mellitus, hepatitis, and iatrogenic factors like prior surgery and catheter usage. The thoracic and lumbar spine are the most common sites of these abscesses. Clinical presentation can include back pain, fever, and neurologic deterioration, with back pain occurring in almost two-thirds of patients. Staphylococcus aureus is the most common causative pathogen. We present a 50 male with no significant past medical or family history who presented with progressive back pain for greater than one week, chills and malaise. Cervical and lumbar spinal CT scans identified epidural abscesses at C6/7 and L5/S1. Blood cultures and surgical cultures from washout of the epidural space grew Streptococcus pneumoniae. The patient was treated successfully with a prolonged course of cefazolin for six weeks. S. pneumoniae is a rare cause of epidural abscesses, especially in patients with no known risk factors for invasive disease. This case demonstrates that invasive pneumococcal disease should remain on the differential diagnosis even in immunocompetent patients.