Paraspinal Tropical Pyomyositis and Epidural Abscesses Presenting as Low Back Pain

Abstract

We present the case of a 13-year-old patient who presented to the Emergency Department with low back and flank pain. Cross sectional imaging revealed paraspinal pyomyositis and epidural abscess. A detailed patient history revealed a recent lower extremity skin infection consistent with tropical pyomyositis. Review of this case shows the importance for recommending either contrast enhanced computed tomography (CT) imaging of the spine and/or magnetic resonance imaging (MRI) in patients with a recent skin infection and acute onset of back pain.

Keywords: CT, computed tomography; MRI, magnetic resonance imaging.

Figure 1

13-year-old wth paraspinal abscesses. Non-contrast enhanced CT imaging of the renal collecting system for the evaluation of nephrolithiasis was negative for calcification. Hypodensity was noted in the left paraspinal musculature on axial imaging using soft tissue window levels (W342/L56) (Figure 1A) but not as well delineated on sagittal images (Figure 1B) using the same display settings. The post contrast axial and transverse CT images demonstrate peripheral wall enhancement (white arrow) consistent with paraspinal abscess (Figure 1C). The reconstructed sagittal imaging demonstrates multilevel abscesses (white arrow).

Figure 2

13-year-old wth paraspinal abscesses. Post Gadolinium lumbar spine MRI in the transverse (Figure 2A, T1 FSE TR/TE 550/10.168 W/L 2470/1065) and sagittal plane (Figure 2B & 2C, T1 FSE TR/TE 466.664/18.708; W/L 1385/692) confirm the paraspinal musculature abscesses (white arrows) and epidural abscess (black arrow).