Presentation
Two-week history of progressive leg pain and difficulty walking. Reduced distal proprioception. Recent antibiotic therapy for lower limb cellulitis (started abroad, with a history of lumbar puncture).
Patient Data
Large loculated dorsal epidural collection (extending from T11 to L5 level). Spinal canal narrowing and cauda equina compression at L2/3 and L3/4 levels. Conus compression at T12/L1.
Extensive inflammatory phlegmon in the paraspinal tissues, including distinct small left psoas and posterior paraspinal abscesses at L3 level.
Background spinal degeneration (including T7 anterior compression fracture) but no features of spondylodiscitis. Normal cord signal.
6 wk later following decompression washout & targeted antibiotic Rx
Post L2/3 laminectomies / intraspinous decompression.
No residual spinal canal collection nor abnormal enhancement. No residual paraspinal collection. No neural compression.
Case Discussion
Dramatic appearances with a large dorsal lumbar epidural abscess, causing cauda equina compression.
Streptococcus dysgalactiae was isolated on PCR from the surgical washout, and post-antibiotic treatment demonstrates the excellent imaging and clinical response.
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