Challenges in diagnosis of spinal epidural abscess: A case report. Issue 5 (February 2019)

• Record Type: Journal Article
• Authors: Yang, Xiaowei; Guo, Runsheng; Lv, Xin; Lai, Qi; Xie, Banglin; Jiang, Xiaozhen; Dai, Min; Zhang, Bin
• Other Names: NA. section editor.
• Is Part Of: Medicine. Volume 98:Issue 5(2019)
• Publication Date: 2019-02
• Subjects: antibiotic therapy -- laminectomy -- magnetic resonance imaging -- misdiagnosis -- spinal epidural abscess -- spinal tuberculosis; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000014196
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Spinal epidural abscess (SEA) is a rare condition that shows a high prevalence in immunocompromised patients. The clinical presentation of SEA includes the "classic triad" of pain, fever, and neurological dysfunction. However, these nonspecific features can lead to a high rate of misdiagnosis. SEA may lead to paralysis or even death; thus, prognosis of these patients remains unfavorable. Patient concerns: We report a case of a multilevel (T6–T12) SEA in a 22-year-old woman. Diagnosis: The patient was initially diagnosed with spinal tuberculosis at a local hospital based on a history of tuberculosis exposure, as well as radiography and computed tomography. Histopathological examination of the tissue resected during laminectomy confirmed the diagnosis of SEA in this patient. Interventions: The patient underwent multilevel laminectomy combined with long-term antibiotic therapy. Outcomes: Physical examination performed 16 months postoperatively revealed that superficial and deep sensation was restored to normal levels in the lower extremities with improvement in the patient's motor function (muscle strength 2/5). Lessons: This case report indicates that whole spine magnetic resonance imaging is warranted in patients with SEA and that prompt surgical intervention is important at symptom onset. Long-term antibiotic therapy is also essential postoperatively.