Spinal Epidural Abscess as a Result of Dissemination from Gluteal Abscess Secondary to Intramuscular Analgesic Injection

Abstract

Spinal epidural abscess is a collection of suppurative material that forms between the dura mater and the ligamentum flavum. If not recognized early and treated correctly, it can lead to life-threatening sepsis. Here we report the case of a female patient, 51 years of age, with difficulty walking and bilateral leg pain after having had degenerative discogenic pain for many years. The patient had occasionally received intramuscular non-steroidal anti-inflammatory drug injections. The current report is that of an unusual case of epidural abscess that formed following multiple dose of intramuscular non-steroidal anti-inflammatory drug over a 1-year period. Hematogenous or direct dissemination is the suspected cause. To prevent serious morbidity and mortality, early diagnosis is essential. Patients with localized back pain who are at risk for developing such epidural spinal abscesses should receive a magnetic resonance imaging scan with contrast enhancement without delay. The existence of predisposing factors such as intramuscular injections should be considered in the assessment of suspected spinal epidural abscess.

A Review of Epidural Catheter-Related Infections

“…32,33 Intravenous drug abusers, patients with dental abscesses, and patients with indwelling central venous catheters are at higher risk of hematogenous spread of infection to the spinal space. 34…”

Disseminated Spinal Epidural Abscess in an Immunocompetent Individual: A Case Report and Review of the Literature

“…When surgical intervention is chosen as the treatment regimen, the primary goals include decompressing the epidural space, draining the abscess, achieving spinal stability, and sampling the abscess to identify the pathogen [3]. As a prognosis, SEA diagnosis and treatment delays directly correspond to worse, often debilitating, permanent neurologic sequela in patients, and sometimes even death outcomes [2,5,7,10,16,21]. By the time the more conspicuous and broad-ranging neurological symptoms have developed, they are often irreversible [7].…”

“…Further diagnostic testing using laboratory and imaging evaluation is required when considering SEA in the differential diagnosis [ 10 , 11 ]. Common blood tests used for diagnostic evaluation of suspected SEA patients include CBC with differential, ESR, and CRP [ 11 ].…”

“…Spinal epidural abscess (SEA) is an uncommon pyogenic infection, localized between the dura mater and vertebral periosteum, leading to significant morbidity and mortality [1][2][3][4][5][6][7][8][9][10]. SEA development is connected with medical comorbidities and risk factors facilitating bacterial dissemination [9].…”

Injectional severe soft tissue infection

“…All cases are listed as a single case report. [6][7][8][9] DS was found to be responsible for the infection in 6 of 7 cases. On the other hand, DS seems one of the widespread used NSAID in Turkey.…”