Atypical Presentation of Spinal Epidural Abscess—Prolonged and Intractable Abdominal Pain

Summary 

Despite advances in medicine, early diagnosis of spinal epidural abscess remains a challenge to clinicians. The most common symptoms of spinal epidural abscess include back pain, fever, and neuralgic deficits. However, spinal epidural abscess can also present with vague and nonspecific symptoms. In this case, a 68-year-old male had abdominal pain in the right upper quadrant lasting 3 weeks and was diagnosed with a gastric ulcer. After treatment, his symptoms did not resolve. Fever and back pain became evident as his disease progressed, followed by right lower limb weakness and the inability to walk. He was taken to the emergency department of our hospital, and the weakness of his lower extremities worsened during hospitalization. His right leg became completely paralyzed despite the use of intravenous antibiotics. A spinal computed tomography scan was performed emergently (magnetic resonance imaging was unavailable) and revealed an epidural abscess involving T5–6 with adjacent osteomyelitis. The patient underwent posterior decompressive laminectomy with pus drainage in the T4–7 region. His neuralgic examinations improved soon after the operation, but ambulation remained limited. Early diagnosis is crucial to the prognosis of spinal epidural abscess, because delayed diagnosis usually results in complete paralysis even death. Thus, clinicians should be aware of atypical presentations of spinal epidural abscess.

Key Words:  abdominal pain , epidural abscess , osteomyelitis

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