Post-operative Microdiscectomy Complicated by Lumbar Epidural Hematoma with Cauda equina Syndrome Following Dual Viral Infection: A Rare Case Report and Its Management

Introduction: Spontaneous spinal hemorrhage in dengue fever is extremely rare. We report a case of post-operative microdiscectomy complicated by delayed (>72 h) spontaneous lumbar epidural hematoma leading to cauda equina syndrome, having severe thrombocytopenia with dual viral infection (dengue and chikungunya) in a known case of chronic lymphoid leukemia (CLL). The patient was managed with transfusion of platelets followed by revision surgery with the evacuation of hematoma with lumbar decompression, following which the patient improved gradually. Although cases of symptomatic spinal epidural hematoma and post-viral infection have been reported, post-microdiscectomy together with CLL is not reported in literature. Case Report: A 62-year-old male with known hypertension and CLL presented with severe low back pain and left anterior thigh radiation, who underwent uneventful microscopic discectomy for L2–L3 disc sequestration. On post-operative day 4, the patient developed cauda equina syndrome with concurrent dengue and chikungunya infections, and magnetic resonance imaging revealed an extradural hematoma at L3–L5 level. After medical optimization with platelet transfusions and steroids, the patient underwent emergency surgical evacuation of the hematoma. Conclusion: In post-operative microdiscectomy, delayed spontaneous spinal hematoma with cauda equina syndrome having dual viral fever (dengue and chikungunya) with CLL is a rare complication. Failure to recognize can lead to devastating outcomes with permanent neurological impairment. Prompt medical optimization following close clinico-serological monitoring with early surgical evacuation is needed. Early diagnosis with intervention can significantly improve the neurological outcome. Keywords: Spinal epidural hematoma, dengue fever, chikungunya, microdiscectomy, thrombocytopenia, leukemia.