Case history
Case history #1
A 50-year-old man presents to the emergency department with a 3-week history of increasing back pain. He also reports previous intravenous drug use. On examination, he has tenderness in the lumbar region, some paravertebral spasm, and a temperature of 102°F (39°C). Laboratory investigations show a white blood cell count of 16,000/microliter, elevated erythrocyte sedimentation rate (150 mm/hour), and elevated C-reactive protein (110 mg/L). Plain spinal x-rays are unremarkable. Computed tomography of the lumbar spine suggests discitis at the fourth lumbar interspace, and magnetic resonance imaging (MRI) reveals an enhancing epidural mass at L3 to L5.
Case history #2
A 40-year-old woman with HIV infection presents to the emergency department with a 5-day history of weakness in the lower extremities. On examination she is afebrile. Laboratory investigations and spinal x-rays are unremarkable. MRI shows an enhancing epidural process from T10 to L5.
Other presentations
In patients with spinal epidural abscess (SEA), pain can be chronic, with referred pain to the abdomen or chest cavity, especially when the infection starts in a paravertebral site. Other presentations include apparent vascular or neurogenic claudication and fever with no obvious cause. Some patients present after spinal trauma or spinal surgery. SEA may develop after spinal anesthesia, and this presentation is increasing in industrialized nations.[4][5]
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