Spinal Epidural Abscess Following Spinal Anesthesia in a Bacteremic Patient: A Case Report

Spinal epidural abscess (SEA) is an uncommon but potentially life-threatening complication that requires prompt recognition to prevent permanent neurological injury. Its occurrence after spinal anesthesia is particularly unusual and presents a diagnostic challenge because the initial symptoms may resemble expected post-operative pain.

We describe the case of a 31-year-old woman who developed severe lower back pain and progressive lower limb weakness after undergoing spinal anesthesia for repeated debridement of necrotizing fasciitis in the presence of methicillin-sensitive Staphylococcus aureus bacteremia. Advanced spinal imaging demonstrated an extensive lumbar epidural infection associated with vertebral and paravertebral involvement, necessitating urgent surgical decompression. Operative findings confirmed a significant epidural purulent collection with widespread inflammatory tissue, and microbiological cultures were consistent with the bloodstream pathogen.

Following surgery and targeted antimicrobial therapy, the patient experienced marked improvement in pain, neurological function, and mobility. This case highlights the importance of maintaining a high index of suspicion for SEA in patients with persistent back pain and evolving neurological symptoms after neuraxial anesthesia, particularly when bacteremia is present. Early diagnosis and timely intervention are essential for achieving favorable clinical outcomes.