Spinal epidural abscess (SEA) is a surgical emergency if it causes paraplegia. Staphylococcus aureus and streptococci are the most common causes. Streptococcus gallolyticus has been reported to cause SEA only on three occasions earlier—all were associated with endocarditis or colonic malignancy. We report an older woman with diabetic ketoacidosis who presented with poorly localised back pain, fever and altered sensorium. Her lumbar puncture revealed frank pus, and MRI showed an SEA. She could not be weaned from mechanical ventilation post-surgical decompression, and she succumbed to ventilator-associated pneumonia. A triad of fever, back pain and neurological deficit should lead one to consider intraspinal suppuration. This report is the first S. gallolyticus-related SEA from India and the first in literature that was not associated with either endocarditis or colonic malignancy.

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Emphysematous pyelonephritis (EPN) is an uncommon necrotizing infection commonly seen in people with diabetes. Emphysematous osteomyelitis (EOM) is a rare form of pyogenic osteomyelitis characterized by the presence of air in the bones. A combination of both these infections has been reported only thrice in the literature. We present the case of a middle-aged diabetic woman who had both these rare infections along with psoas abscesses, a phenomenon that has been described only once previously. The patient required prolonged hospitalization, surgical debridement and drainage, a double-J stent, and meropenem, and she subsequently achieved full recovery.

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Malignant peripheral nerve sheath tumor (MPNST) is a rare, aggressive sarcomatous tumor that arises from peripheral nerve sheath and shows Schwann cell differentiation. They are commonly seen among cases with existing benign plexiform neurofibromas, prior radiation treatment, and large germline mutations involving the entire neurofibromatosis 1 (NF1) gene. MPNST can have varied presentations; hence diagnosis remains a great challenge. Here we report a rare case of MPNST in an NF1 patient who presented with Horner´s syndrome. A young male reported swelling in the neck, dyspnea on exertion, and dysphagia. Subsequently, he was diagnosed to have a malignant peripheral nerve sheath tumor arising from the mediastinum and compressing the ipsilateral cervical sympathetic plexus causing Horner′s syndrome. The patient underwent surgical resection of the mediastinal mass followed by chemotherapy. His symptoms improved significantly following treatment. This case report emphasizes the fact that high suspicion of MPNST is required when NF1 cases present with mass lesions, so that early surgical clearance with chemoradiation may offer a nearcomplete cure.