Background: Spinal epidural abscesses are rare and are misdiagnosed in up to 75% of cases. Fever, back pain, and neurological deficits are part of the classical triad. Here, the authors report a patient with a L2-L5 spinal epidural abscess with the left paravertebral extension attributed to acute pyelonephritis.
Case Description: A 54-year-old female presented with persistent low back pain and lower extremity weakness accompanied by paresthesias. Previously, she had been hospitalized with the left acute pyelonephritis. The lumbosacral MRI documented a T12/L5 anterior epidural abscess with ring enhancement on the contrast study; the maximum diameter of the abscess at the L2-L3 level contributed to severe cauda equina compression. She underwent a L2/L4 decompressive laminectomy with drainage of the intraspinal/extradural and paravertebral components. Intraoperative microbiological sampling grew for which she then received targeted antibiotic therapy. Fifteen days later, she was walking adequately when discharged.
Conclusion: Thoracolumbar epidural abscesses are rare. They must be considered among the differential diagnoses when patients present with acute back pain, fever, and new neurological deficits following prior treatment for acute pyelonephritis.
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http://dx.doi.org/10.25259/SNI_260_2022 | DOI Listing |
Cureus
December 2024
Internal Medicine, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Chaves, PRT.
Cervical and lower back pain are classic reasons for patients to seek care in the emergency department (ED). However, in rare instances, they signal serious underlying conditions, posing a significant diagnostic challenge. A 72-year-old male with history of lumbar spine surgery many years ago presented to the ED with neck pain for the last five days as well as bilateral lower limb weakness and feet paresthesia.
View Article and Find Full Text PDFCureus
December 2024
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
Pyogenic spinal infections due to ()are rare. After a search of the literature, we deemed our case to be the first description of spinal epidural abscess (SEA) from . This is a 74-year-old female patient with a history of diabetes who presented to the emergency department with fever and persistent paracervical pain after being initially diagnosed with viral sinusitis two days prior.
View Article and Find Full Text PDFCureus
December 2024
Intensive Care Unit, Unidade Local Saúde Viseu Dão-Lafões, Viseu, PRT.
Cureus
November 2024
Department of Internal Medicine, Aga Khan University Hospital, Nairobi, KEN.
Post-dural puncture headaches usually occur when the cerebrospinal fluid (CSF) leaks due to trauma to the dura mater. This often results in spontaneous intracranial hypotension characterized by orthostatic headaches, neck stiffness, and nausea. In this case report, we discuss a 20-year-old male patient who developed symptoms of intracranial hypotension one year following a lumbar puncture.
View Article and Find Full Text PDFNeuroSci
December 2024
Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Poznań, Poland.
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