Management of spontaneous spinal epidural abscess: A case report

Background: Spinal epidural abscess (SEA) is a rare but severe pyogenic infection of the epidural space. Case presentation: A 60-year-old female with a history High Blood Pressure, Chronic Renal Failure and the non-surgical descending aortic aneurysm was hospitalized 10 days before its symptoms in the intensive care unit for treatment of acute infective endocarditis caused by Staphococcus aureus. She presented 24 hours before a lower limb motor weakness, bladder and bowel dysfunction (urinary and anal incontinence).MRI spine with gadolinium demonstrating an epidural contrast-enhancing mass extending from mid Th10 to Th12 left-side with infiltration of the pedicles and extension to the soft tissues and is most consistent with epidural abscess. Within the next few hours the patient underwent decompressive laminectomy (level Th10-Th12) and surgical evacuation of the abscess. The post-operative cultures from the abscess were positive for Staphylococcus- aureus. Intravenous antibiotics were continued, and active neurorehabilitation was initiated. Immediate improvement of the paralysis and sphincter function was observed as a result of the surgical decompression. Conclusion: The incidence of spinal epidural abscess is increasing with the aging of the population and the frequency of immunocompromising diseases. The most common causative agent is Staphylococcus. Aureus. The signs and symptoms of epidural abscess are non-specific. Empiric antibiotic therapy and emergency surgical decompression improve the prognosis.