Spontaneous spinal epidural abscess: A case report

Introduction: Spinal epidural abscess (SEA) is an uncommon but serious infection involving the epidural space that may lead to irreversible neurological damage if not diagnosed and treated promptly. Early recognition is often difficult because clinical manifestations are variable and may occur without identifiable risk factors. 

Case presentation: We report the case of a 58-year-old man with a history of chronic alcohol and tobacco use who presented with sudden bilateral lower limb paralysis associated with urinary dysfunction. In the months preceding admission, he described progressive fatigue, intermittent dorsal pain, and lower limb paresthesia without any history of trauma or invasive procedures. Neurological examination revealed complete motor deficit of both lower extremities with a sensory level below the umbilicus. Imaging studies, including computed tomography and magnetic resonance imaging, demonstrated a posterior epidural collection extending from the sixth to the twelfth thoracic vertebral levels, causing marked spinal cord compression with extension into adjacent paraspinal tissues. The patient underwent urgent decompressive laminectomy with evacuation of purulent material. Microbiological analysis identified Staphylococcus aureus, and appropriate intravenous antibiotic therapy was initiated. Partial neurological recovery was observed postoperatively. 

Conclusion: This case highlights the importance of considering spinal epidural abscess in patients presenting with acute or progressive neurological deficits and emphasizes the role of early imaging and prompt combined surgical and antimicrobial management in improving outcomes.