SHM Converge Scientific Abstract ePoster Gallery-Spontaneous Epidural Abscess With Pyelonephritis: A Rare Case of Dual Infections and Diagnostic Challenge.

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This case describes a 56-year-old woman with a history of insulin-dependent diabetes and remote cervical cancer who presented with worsening chronic low back pain, diaphoresis, tachycardia, and laboratory evidence of leukocytosis, metabolic acidosis, hyperglycemia, and ketonuria consistent with diabetic ketoacidosis. She was initially treated for suspected pyelonephritis after CT showed right hydroureteronephrosis and cultures were obtained. However, because her back pain persisted and she developed muscle cramps, MRI of the thoracic/lumbar spine was performed and revealed L5-S1 osteomyelitis, discitis, and an anterior spinal epidural abscess causing canal stenosis.<br /><br />The diagnosis was complicated by concurrent urinary infection and differing organisms in blood and urine cultures. Urine cultures grew Klebsiella pneumoniae and Escherichia coli, while blood cultures grew Streptococcus constellatus. Additional workup, including maxillofacial CT and transesophageal echocardiography, found no alternate source such as abscess or endocarditis. Bone biopsy confirmed acute osteomyelitis and excluded malignancy.<br /><br />She was managed in the ICU for DKA and treated with broad-spectrum antibiotics (cefepime and vancomycin), later narrowed to ceftriaxone based on sensitivities. Neurosurgery recommended non-operative management because she remained neurologically intact and her pain improved. Inflammatory markers trended down, repeat cultures were negative, and she was discharged on a 7-week course of IV ceftriaxone.<br /><br />The case highlights the importance of maintaining a broad differential for persistent back pain, especially in patients with diabetes or cancer history, and considering spinal epidural abscess even without neurological deficits. Early recognition and prolonged antibiotic therapy can allow successful conservative treatment in stable patients.

Asset Subtitle

Rohi Mishra

Meta Tag

Author List Barney Soskin, Poornachandran Mohankumar, Rodolfo Myronn De Melo Rodrigues, Rodrigo Furlan Silva Fabri, Rohi Mishra

Category Clinical Vignettes

Concept Spinal Epidural Abscess

Concept Back Pain

Concept Magnetic Resonance Imaging

Concept Intravenous Antibiotic Therapy

Concept Neurologic Deficit

Distinguished Non-Finalist

Presenter Organization Texas Tech University Health Sciences Center El Paso Transmountain

Presenting Author Rohi Mishra

Track Adult

Keywords

diabetic ketoacidosis

spinal epidural abscess

osteomyelitis

discitis

low back pain

Streptococcus constellatus

Klebsiella pneumoniae

Escherichia coli

MRI spine

IV ceftriaxone

Spinal Epidural Abscess

Back Pain

Magnetic Resonance Imaging

Intravenous Antibiotic Therapy

Neurologic Deficit