Pneumococcal Epidural Abscess in an Asplenic Patient Presenting After Mild Hip Trauma

Abstract

We report a unique presentation of an epidural abscess following mild trauma in a patient with asplenia. The patient reported subjective fever and marked pain along the right hip and flank, which are atypical locations for epidural abscess pain. A subsequent urinalysis showed leukocytes, and the diagnosis of an epidural abscess was missed until the patient presented over two weeks later with fever, spinal pain, leg weakness, and urinary incontinence. This report highlights the importance of heightened clinical suspicion of pneumococcal infections in asplenic patients with unexplained subjective fever. Cost-effective yet sensitive tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can help guide further investigation of epidural abscesses in such patients. Blood and urine cultures may also be warranted. Early diagnosis of epidural abscesses is essential to ensure improved outcomes.

Epidural abscess secondary to Streptococcus pneumoniae. A case report and review of the literature

“…A literature review of S. pneumoniae spinal infections from 1906 to 2012 identified 52 cases with 19 adult cases involving the epidural space [6] . Since 2012 four additional cases of S. pneumoniae SEA have been identified [12] , [13] , [31] , [32] .…”