A Case of Unremitting Back Pain Leading to the Diagnosis of a Large Spinal Epidural Abscess

Author(s): Andrea Lauffer, Jiayan Wang, Charles Meadows, Michelle Worthy

Spinal epidural abscess (SEA) is a rare disease with a significant rate of morbidity and mortality. The triad comprised of back pain, fever, and neurological deterioration is observed only in 8 to 15% of cases. We present a 48-year-old Caucasian female with a history of migraines, anemia, and morbid obesity. She presented to walk in clinic (WIC) with severe, unremitting back pain for 10 days. She was seen multiple times prior at the emergency department (ED) and outpatient clinics. She presented with severe back pain with numbness in her arms despite prior conservative treatments. On exam, she was significantly tender along her thoracic spine with numbness in bilateral upper extremities. Patient was admitted to the hospital for an urgent MRI of the spine which revealed a large epidural abscess extending from C2 through T12 with long segment effacement of the thecal sac and cord compression with cord edema at the upper thoracic levels noted. Neurosurgery was consulted emergently and performed C2- T10 decompressive laminectomy and fusion. Broad spectrum intravenous antibiotics were started and deescalated after cultures grew methicillinsensitive Staphylococcus aureus. Pain and upper extremity numbness slowly improved after surgery. Upon further review of her history, she had Botox injections for migraines in her cervical paraspinal muscles two weeks prior to presentation which could have been a possible risk factor leading to her developing a SEA.