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Case Reports
. 2022 Jul 27;14(7):e27346.
doi: 10.7759/cureus.27346. eCollection 2022 Jul.

Spontaneous Multiloculated Lumbar Abscess in a Middle-Aged Male With Unexplained Progressive Back Pain and Muscle Weakness

Mary Ann Nyc  1 , La'Kesha Francis  2 , Jason R Woloski  3
Affiliations
Case Reports

Spontaneous Multiloculated Lumbar Abscess in a Middle-Aged Male With Unexplained Progressive Back Pain and Muscle Weakness

Mary Ann Nyc et al. Cureus. .

Abstract

A 54-year-old man with a past medical history significant for sciatica, as well as multiple orthopedic surgeries with hardware, was transferred from an outside rural facility for further workup of a two-month history of progressive back pain and muscle weakness. Investigations ultimately revealed abnormal enhancement from T11 to sacrum, with a large epidural abscess from L5 to the sacrum, best visualized on an MRI. Following the MRI confirmation of loculated complex thoracolumbar abscess, neurosurgery performed a left L3-S1 unilateral laminotomy and evacuation of compressive multiloculated epidural abscesses. The patient was then treated with empirical antimicrobial coverage for epidural abscess with vancomycin and ceftriaxone, which was narrowed to cefazolin based on positive methicillin-susceptible Staphylococcus aureus (MSSA) wound cultures obtained in the operating room. The patient completed a total six-week course of antibiotic therapy. Apart from some superficial wound dehiscence postoperative, the patient ultimately recovered well and had a resolution of most presenting symptoms.

Keywords: atypical back pain; back pain; lower extremity weakness; spinal epidural abscess; treatment of spinal epidural abscess.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. MRI (SAG T1 + contrast sequence) showing a long segment of epidural enhancement compatible with epidural phlegmon/abscess, extending T12 through the imaged sacral levels, which contributes to a varying degree of the spinal canal and neural foraminal narrowing
SAG: Sagittal.
Figure 2
Figure 2. MRI (SAG T2 sequence) showing peripherally enhancing abscess spanning the approximate upper/mid-L3 vertebral body level to the superior L4 vertebral body level, located within the left posterior epidural space of the spinal canal
SAG: Sagittal.
Figure 3
Figure 3. MRI (axial T2 sequence) showing multifocal left paraspinal abscesses and phlegmon, with some possible communication: T2 hyperintense left paraspinal collection at the approximate L4 level measures roughly 1.4 cm (AP) x 1.5 cm (TRV) x 2.8 cm (SI) and abuts the dorsal aspect of the left L3-L4 facet joint.
AP: Anteroposterior; TRV: Transverse; SI: Superior to inferior.
See this image and copyright information in PMC

References

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