International Journal of Gerontology
Volume 3, Issue 4 , Pages 244-247, December 2009

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

  • Cheng-Chih Lin

      Affiliations

    • Division of Infectious Disease, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Chang-Pan Liu

      Affiliations

    • Division of Infectious Disease, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan
    • ,
  • Chun-Ming Lee

      Affiliations

    • Division of Infectious Disease, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Chun-Ming Lee, Division of Infectious Disease, Department of Medicine, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 104, Taiwan
    • ,
  • Hsiang-Kuang Tseng

      Affiliations

    • Division of Infectious Disease, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Wei-Sheng Wang

      Affiliations

    • Division of Infectious Disease, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Chen-Feng Kuo

      Affiliations

    • Division of Infectious Disease, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan

Accepted 4 March 2009.

Article Outline

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

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Morgagni GB . In:  Alexander B editors. The Seats and Causes of Diseases Investigated by Anatomy (De sedibus et causis morborum peranatomen indagatis) . New York: Hafner; 1960;p. 220–222
  2. Darouiche RO . Spinal epidural abscess . N Engl J Med . 2006;355:2012–2020
  3. Chen WC , Wang JL , Wang JT , et al.   Spinal epidural abscess due to Staphylococcus aureus: clinical manifestations and outcomes . J Microbiol Immunol Infect . 2008;41:215–221
  4. Darouiche RO , Hamill RJ , Greenberg SB , et al.   Bacterial spinal epidural abscess: review of 43 cases and literature survey . Medicine (Baltimore) . 1992;71:369–385
  5. Choma T , Burke M , Kim C , et al.   Epidural abscess as a delayed complication of spinal instrumentation in scoliosis surgery: a case of progressive neurologic dysfunction with complete recovery . Spine (Phila Pa 1976) . 2008;33:E76–E80
  6. Schroeder TH , Krueger WA , Neeser E , et al.   Spinal epidural abscess—a rare complication after epidural analgesia for labour and delivery . Br J Anaesth . 2004;92:896–898
  7. Reihsaus E , Waldbaur H , Seeling W . Spinal epidural abscess: a meta-analysis of 915 patients . Neurosurg Rev . 2000;23:175–205
  8. Pereira CE , Lynch JC . Spinal epidural abscess: an analysis of 24 cases . Surg Neurol . 2005;63(Suppl 1):S26–S29
  9. Ladhani S , Phillips SD , Allgrove J . Low back pain at presentation in a newly diagnosed diabetic . Arch Dis Child . 2002;87:543–544
  10. Danner RL , Hartman BJ . Update of spinal epidural abscess: 35 cases and review of the literature . Rev Infect Dis . 1987;9:265–274
  11. Davis DP , Wold RM , Patel RJ , et al.   The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess . J Emerg Med . 2004;26:285–291
  12. Lu CH , Chang WN , Lui CC , et al.   Adult spinal epidural abscess: clinical features and prognostic factors . Clin Neurol Neurosurg . 2002;104:306–310
  13. Curry WT , Hoh BL , Amin-Hanjani S , et al.   Spinal epidural abscess: clinical presentation, management, and outcome . Surg Neurol . 2005;63:364–371
  14. Soehle M , Wallenfang T . Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes . Neurosurgery . 2002;51:79–85
  15. Hlavin ML , Kaminski HJ , Ross JS , et al.   Spinal epidural abscess: a ten-year perspective . Neurosurgery . 1990;27:177–184
  16. Khanna RK , Malik GM , Rock JP , et al.   Spinal epidural abscess: evaluation of factors influencing outcome . Neurosurgery . 1996;39:958–964
  17. Bremer AA , Darouiche RO . Spinal epidural abscess presenting as intra-abdominal pathology: a case report and literature review . J Emerg Med . 2004;26:51–56
  18. Lam F , Hynes M . Epidural abscess misdiagnosed as cholecystitis . Emerg Med J . 2001;18:230

PII: S1873-9598(10)70008-9

doi:10.1016/S1873-9598(10)70008-9

International Journal of Gerontology
Volume 3, Issue 4 , Pages 244-247, December 2009

Article Tools