Spinal epidural abscess due to acute pyelonephritis

Background: Spinal epidural abscesses are rare and are misdiagnosed in up to 75% of cases. Fever, back pain, and neurological deficits are part of the classical triad. Here, the authors report a patient with a L2-L5 spinal epidural abscess with the left paravertebral extension attributed to acute pyelonephritis. Case Description: A 54-year-old female presented with persistent low back pain and lower extremity weakness accompanied by paresthesias. Previously, she had been hospitalized with the left acute pyelonephritis. The lumbosacral MRI documented a T12/L5 anterior epidural abscess with ring enhancement on the contrast study; the maximum diameter of the abscess at the L2-L3 level contributed to severe cauda equina compression. She underwent a L2/L4 decompressive laminectomy with drainage of the intraspinal/extradural and paravertebral components. Intraoperative microbiological sampling grew Staphylococcus aureus for which she then received targeted antibiotic therapy. Fifteen days later, she was walking adequately when discharged. Conclusion: Thoracolumbar epidural abscesses are rare. They must be considered among the differential diagnoses when patients present with acute back pain, fever, and new neurological deficits following prior treatment for acute pyelonephritis.