A rare case of full recovery following delayed presentation of paraplegia secondary to thoracic epidural abscess: A case report and review of the literature

Abstract

Background: Timely diagnosis and prompt management of thoracic epidural abscesses are vital to preventing the onset of irreversible paralysis and death.

Case description: A 39-year-old female was managed initially for non-specific chest pain for 10 days (i.e., diagnosis of respiratory tract infection). After she developed paraplegia (0/5 motor function), a T10 sensory level, and acute urinary retention, a thoracic magnetic resonance with contrast revealed a T3-T7 spinal epidural abscess with cord compression. On review of her lab studies revealed a white blood cell count of 11.03 × 10⁹/L and a C-reactive protein level of 122 mg/dL. Following a T3-T7 laminectomy with evacuation of an extradural empyema, she fully recovered.

Conclusion: This case report emphasizes the need for early recognition, diagnosis, and treatment of thoracic epidural abscesses that are too often mis-diagnosed as respiratory infections.

Keywords: ASIA A; Delayed presentation of thoracic epidural abscess; Thoracic Laminectomy.

Figure 1:

Preoperative magnetic resonance imaging (MRI): (a) Sagittal T1-weighted; (b) T2-weighted (T2W); and (c) axial T2W MRI sequences showing a T3–T7 spinal epidural abscess with significant cord compression.

Figure 2:

Postoperative magnetic resonance imaging (MRI): (a) Sagittal T1-weighted, (b) T2-weighted (T2W), and (c) axial T2W MRI sequences done 48 h postoperatively showed good postsurgical appearances with significant evacuation of the epidural empyema and relief of the cord compression. There was a small volume residual cord signal changed at T5–6.