Disclosures: Sun Lee, DO: No financial relationships or conflicts of interest

Case Description: A 65 year old male with chronic C4 ASIA D tetraplegia, recurrent urinary tract infections and multiple spinal surgeries presented with a complicated urinary tract infection resulting in E coli bacteremia and sepsis. The patient remained hospitalized for atrial fibrillation, chest infections, heart failure and pressure ulcers with intermittent tachycardia and hypotension. Two and a half months later, the patient developed new back pain, chest tightness and a self-audible “click” when repositioning. On examination, there was soft tissue swelling along the thoracic spine and a new T9 sensory level with complete loss of motor function in his lower extremities and sacral segments

Setting: West Roxbury VA Medical Center

Patient: 65 year old male with chronic C4 ASIA D tetraplegia Assessment/

Results: CT Thorax revealed thoracic vertebral osteomyelitis and discitis with complete destruction of the T9 vertebral body and grade 2 retrolisthesis of T8 in relation to T10 with a phlegmon . MRI confirmed complete obliteration of the spinal canal at T8/T9 in addition to multiple peripherally enhancing collections extending to the epidural space, posterior soft tissues and surrounding hardware. The fluid collection was aspirated and confirmed to be E.coli epidural abscesses. Given these findings, patients plan of care consisted of antibiotic therapy with optimization for surgery to undergo revision of spinal hardware.

Discussion: Spinal osteomyelitis with epidural abscess is a rare condition that can cause devastating neurological sequala and death. The difficulty of diagnosis in our case stemmed from the insidious nature of weakness, a prolonged medically complex hospital course that masked the patients functional decline

Conclusion: This case highlights the importance of having a high clinical suspicion for epidural abscess in the setting of back pain and worsening weakness especially in patients with prior SCI or baseline neurological deficits.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/epidural-abscesses-in-setting-of-vertebral-osteomyelitis-in-spinal-cord-injury/