Spinal Epidural Abscess

Patient presents with complaints consistent with possible spinal epidural abscess.  Symptoms include back pain, localized or radicular pain, fever, neurological deficits such as weakness, sensory changes, bowel or bladder dysfunction, and possible gait disturbances.  Onset of symptoms may be acute, subacute, or insidious.  Risk factors elicited include recent spinal surgery, epidural catheter placement, intravenous drug use, immunosuppression, diabetes mellitus, or spinal trauma.  Physical examination reveals tenderness to palpation over the affected spinal level, possible paraspinal muscle spasm, and neurological findings corresponding to the level of spinal cord compression.  Differential diagnosis includes discitis, vertebral osteomyelitis, transverse myelitis, and other causes of myelopathy.  Ordered MRI of the spine with and without contrast to evaluate for the presence of an epidural collection and assess the extent of spinal cord compression.  Laboratory studies including complete blood count with differential, erythrocyte sedimentation rate, C-reactive protein, and blood cultures are obtained to evaluate for infection and assess inflammatory markers.  Neurosurgical consultation obtained for emergent evaluation and management.  Treatment plan may include intravenous antibiotics targeting likely pathogens, surgical drainage or decompression of the abscess, and supportive care including pain management and physical therapy.  Patient education provided regarding the diagnosis, treatment options, potential complications, and the importance of adherence to the prescribed treatment plan.  Further evaluation and management will be based on the patient's response to treatment and evolving clinical picture.  Diagnosis: Spinal epidural abscess.