(515) Mistaken Identity: A Case of a Large Epidural Abscess

Introduction: Spinal epidural abscesses are a rare infection of the central nervous system. While uncommon, An epidural abscess requires a prompt diagnosis and treatment due to the severity of the complications. Often, spinal epidural abscesses present with vague symptoms, most commonly neck and or back pain, fevers, and neurological deficits, though due to the vague symptoms, can go undiagnosed. Risk factors include IV drug use and diabetes. Here we review a case of a large spinal epidural abscess initially thought to be meningitis.

Description: The patient is a 71-year-old male with past medical history of diabetes mellitus type 2 and hypertension who presented to the emergency room with complaints of neck pain with associated stiffness and numbness and tingling in his upper extremities starting one week prior to arrival. He noted numbness and tingling in his upper extremities that was intermittent but becoming more consistent over time.. Patient confirmed chills, rigors, photophobia, and generalized weakness. On arrival, the patient was febrile with temperatures up to 40.2 degrees Celsius. The patient was tachycardic and hypertensive. On exam, strength remained intact in both upper extremities. Brudzinski and bilateral Babinski sign were positive. Initial labs showed a white blood cell count of 17.4 x 10^3/unit, a blood glucose of 275 mg/dL, and a creatinine of 2.4 mg/dL. The patient was started on empiric meningitis treatment. MRI cervical spine was performed and demonstrated a large epidural abscess spanning from C2-T2 levels. Patient then underwent C5-T1 laminectomy for evacuation of the epidural abscess. Cultures returned positive for MSSA. After the procedure, the patient demonstrated weakness in his upper extremities requiring discharge to an acute rehab.

Discussion: In this case, we present a patient who was initially thought to have meningitis and found to have an epidural abscess. The patient in this case demonstrated upper extremity deficits raising the concern for epidural abscess. In addition, the patient was found to have poorly controlled diabetes, a risk factor for developing a spinal epidural abscess. While rare, this case demonstrates the importance of having spinal epidural abscess in your differential, especially when the patient has risk factors and neurological deficits.