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Spontaneous spinal epidural abscess (SEA) is a rare infection of the central nervous system. We report a case of a 25-year-old G3 P0020 at 36 weeks of gestational age with history of intravenous drug abuse presenting with acute-onset and severe back pain. Despite antibiotic therapy, pain worsened and she developed lower extremity weakness. Magnetic resonance imaging (MRI) revealed an SEA, and cesarean delivery was performed secondary to increasing weakness, followed by laminectomy (T9-12) and decompression of epidural abscess. Postoperative course was complicated by a psoas muscle abscess and persistent SEA refractory to antibiotic therapy, requiring surgical reexploration and extended treatment with antibiotics. She was discharged home in stable condition and neonate did well with no resulting sequelae. Spinal epidural and psoas abscesses are rare and diagnosis is often delayed. Prompt recognition and treatment are necessary to prevent catastrophic neurologic consequences, and the diagnosis should be considered in pregnant patients presenting with back pain, especially in those with risk factors.

The diagnostic yield (pathogenic or likely pathogenic (P/LP) variants) was compared in fetuses with one structural anomaly, multiple structural anomalies, and effusions or nonimmune hydrops (NIHF) with or without a concurrent structural anomaly. Cases with a single structural anomaly + polyhydramnios or growth restriction (FGR) were categorized as multiple anomalies, and cases with an effusion or NIHF and a structural anomaly were categorized as hydrops. We also compared the proportion of variants of uncertain significance that were thought to potentially be associated with the phenotype across these subgroups (VUS). Chi square or Fisher's exact test compared proportions and logistic regression generated odds ratios. RESULTS: The cohort included 315 pregnancies with median age 33 years (IQR 29-36), 45.1% (142/315) nulliparous, and median gestational age at diagnosis of anomaly of 22.3 weeks (IQR 20.0-25.7). In all, 19.7% (62/315) had a single structural anomaly, 25.4% (80/315) had multiple anomalies, and 54.9% (173/315) had effusions/NIHF. The overall diagnostic yield of ES was 22.9% (72/315). The yield for isolated anomalies was 16.1% (10/62), for multiple anomalies was 17.5% (14/80), and for effusions/NIHF was 27.8% (48/173) (p¼0.07) (Table ). The OR for diagnostic yield of ES (P/LP) for multiple anomalies vs a single anomaly was 1.31 (95% CI 0.54-3.16) and for effusions/NIHF vs a single anomaly was 1.47 (95% CI 1.03-2.11). CONCLUSION: The diagnostic yields of ES for single or multiple structural anomalies are similar, while the yield in cases of NIHF is higher. Further study is needed to identify optimal candidates for prenatal ES.

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