A presentation of spinal epidural abscess in a seven-year-old VACTERL patient: a case report

Spinal epidural abscess is a rare but potentially life-threatening infection of the central nervous system. VACTERL association is a rare congenital condition characterized by vertebral, anal, cardiac, tracheoesophageal, renal, and limb anomalies.

We report a 7-year-old Arab male with VACTERL association presenting with back pain, fever, and gait difficulty. Laboratory studies showed leukocytosis (27 × 10⁹/L) and anemia (Hb 9 g/dL). MRI revealed multiloculated cystic lesions with thick walls and mixed fluid-gas content extending from T4 to L5, forming an extensive epidural abscess with paraspinal extension and vertebral erosions. The patient was treated with intravenous vancomycin, metronidazole, and imipenem, followed by surgical drainage and local vancomycin irrigation. Clinical condition improved markedly, and he was discharged after two months in good health.

This case highlights the diagnostic challenges of SEA in children with complex congenital anomalies and emphasizes the importance of early recognition and multidisciplinary management.