Spinal epidural abscess of uncommon presentation following urinary tract infection: A case report

Abstract

BACKGROUND

An epidural abscess is a rare but serious medical condition where a pocket of pus forms in the epidural space — the area between the outer covering of the spinal cord (the dura mater) and the bones of the spine. It’s usually caused by a bacterial infection, most commonly Staphylococcus aureus. The infection can spread to this area from other parts of the body, through the bloodstream, or it may be introduced directly during spinal procedures like epidural injections or surgery. Symptoms often include severe back pain, fever, and neurological deficits like weakness or numbness, which can progress quickly if untreated. It's considered a medical emergency because if the abscess compresses the spinal cord, it can lead to permanent paralysis or even death. Treatment usually involves antibiotics and, in many cases, surgical drainage.

CASE SUMMARY

Spinal epidural abscess (SEA) represents a rare yet potentially severe infection affecting the epidural space. We present the following case of a 54-year-old Hispanic white male who initially presented to the emergency department with acute deteriorating symptoms of bilateral lower extremity weakness, which subsequently progressed to involve the upper extremities. However, further evaluation uncovered additional notable symptoms, including urinary incontinence and decreased appetite. Further investigation broadened the differential diagnosis, including meningitis, spinal cord compression, acute pyelonephritis, osteomyelitis, bacteremia, torticollis, and acutely progressive ascending bilateral lower extremity weakness, raising the concern for possible Guillain-Barre syndrome. Diagnostic imaging, including magnetic resonance imaging of the spine, confirmed the presence of C5-C6 osteomyelitis and a C6-C7 spinal epidural abscess with severe canal narrowing. The patient underwent an emergency evacuation of epidural abscess with a C6 corpectomy and C5-C7 cervical fusion, followed by an 8-week course of intravenous antibiotics. Cultures from the abscess and bone revealed Staphylococcal aureus. The patient was discharged after 54 days with significant improvement in power and function.

CONCLUSION

This case highlights the importance of maintaining a high index of suspicion for SEA in patients presenting with atypical symptoms, even in the setting of seemingly unrelated conditions. Early recognition and prompt intervention are crucial to prevent permanent neurological deficits and improve outcomes in patients with SEA.

Keywords: Epidural abscess; Torticollis; GBS guillan_barre_syndrome; Case report

Core Tip: This case report presents an unusual clinical scenario describing a 54-year-old male who was admitted after acute deteriorating symptoms of bilateral lower extremity weakness, which subsequently progressed to involve the upper extremities. Unexpectedly, neuroimaging, magnetic resonance imaging of the spine, confirmed the presence of C5-C6 osteomyelitis and a C6-C7 spinal epidural abscess with severe canal narrowing. This imaging finding was remarkable given the significant neurological deficits. Surgical intervention started with long term antibiotics that improved the patient’s symptoms. Other info: (1) Informed consent was obtained; (2) Does not apply to case reports; (3) Manuscript has been reviewed multiple times; and (4) Spinal epidural abscess. The case has an educational value regarding rare occurrence of spinal epidural abscess after a urinary tract infection.