Disclosures: Mia Song, DO: No financial relationships or conflicts of interest

Case Description: A 55 year old female with a history of acoustic neuroma with obstructive hydrocephalus, neurogenic bowel/bladder, and recurrent sinusitis presented to the emergency room with acute on chronic low back pain and progressive lower extremity weakness. She saw multiple physicians previously where her symptoms were repeatedly attributed to lumbar radiculopathy. She was prescribed physical therapy and pharmacologic regimens which failed to alleviate symptoms. On admission, lumbar spine MRI with and without contrast showed large lumbar anterior and posterior epidural abscesses. The patient never had fevers and denied history of intravenous drug abuse.

Setting: Inpatient hospitalization; PM&R consult service

Patient: 55 year old female with epidural abscess Assessment/

Results: Inpatient workup revealed methicillin- sensitive Staphylococcus aureus (MSSA) bacteremia, mitral-valve endocarditis, and retroperitoneal fluid collection. Further questioning revealed a history of recent outpatient rhinoscopy for the patient’s chronic sinusitis prior to presentation. It is believed that instrumentation led to transient MSSA bacteremia and resultant bacterial endocarditis, eventually seeding the epidural space. She underwent a T10-11 and L2-3 laminectomy with abscess evacuation, percutaneous drainage of retroperitoneal collection, and a prolonged course of antibiotics. Given her ambulation deficits requiring two-person assistance, a decline from her baseline of modified independence, the PM&R consultant team recommended acute inpatient rehabilitation, where the patient was subsequently discharged.

Discussion: Low back pain is among the most common presenting complaints in clinic. In patients with chronic low back pain with known neurological deficits including bowel/bladder symptoms, subjective complaints may require heightened awareness of red flags to prevent anchoring bias. As musculoskeletal experts, physiatrists should remember that underlying neurological symptoms do not preclude development of new ones, and that change in functional status warrants aggressive investigation.

Conclusion: Epidural abscesses can present with acute back pain with ambulatory dysfunction in the absence of fever. Change in functional ambulation warrants aggressive investigative work up.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/nontraumatic-spinal-cord-injury-due-to-epidural-abscess-presenting-as-low-back-pain-a-case-report/