Disclosures: Christian W. Roehmer, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 58-year-old immunosuppressed female diagnosed with spinal epidural abscess.

Case Description: A 58-year-old female with a past medical history of rheumatoid arthritis, on chronic suppressive steroids, presented with low back pain. The pain had begun two weeks prior as low, mid-axial back pain, described as stabbing and 10/10 in severity. She endorsed “unusual sensations” in bilateral lower extremities, without numbness or weakness. The patient had recently been seen in an emergency department (ED) for severe pain and had found relief with intravenous (IV) analgesics. Imaging at that time was significant for “degeneration of her discs.” Between her ED and clinic visits, the patient experienced three episodes of urinary incontinence.

Setting: Outpatient pain clinicAssessment/

Results: The patient was sent immediately for an MRI without contrast that was found to be concerning for cyst formation or tethering of the spinal cord in the lower lumbar region, based on unusual densities. A contrasted MRI was recommended and showed extensive epidural enhancement throughout the lumbar spine, reflective of multiple abscesses, which were causing severe compression of the cauda equina. The patient was sent to neurosurgery and admitted for posterior lumbar laminectomy, along with removal of lesions (pathology consistent with abscess), and an extended course of IV antibiotics.

Discussion: Spinal epidural abscess is an uncommon condition that can be fatal if not recognized early. A common risk factor for development includes immunosuppression, as was seen in this case. Signs and symptoms of spinal epidural abscess can range from low back pain to severe neurological compromise or sepsis. Treatment usually involves surgical decompression, followed by a course of IV antibiotics.

Conclusion: A thorough history is important when diagnosing low back pain, especially when evaluating immunosuppressed patients. Spinal epidural abscesses can cause substantial morbidity and mortality, and providers should be familiar with its clinical features, diagnostic workup, and treatments.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/diagnosis-and-management-of-spinal-epidural-abscess-a-case-report/