Spondylodiscitis with epidural and bilateral psoas abscesses

Discussion:

The patient had a history of fall 7 weeks prior to presentation, with L5 vertebral fracture. Subsequent outpatient CT (not available) for investigation of increasing pain demonstrated L4/L5 endplate erosions with paravertebral mass, suspicious for spondylodiscitis. The patient was referred to ED, and shortly after became febrile and with CRP >200, WCC 13. Blood cultures grew Steptococcus anginosus (milleri)

His neurological examination remained reassuring, so the decision was made to manage non-operatively. The psoas aspirate sent for culture grew Streptococcus anginosus. Approx 100 mL of purulent material drained over the next 48 hours, with gradually reducing output. The drain was removed after 10 days. The patient responded to drainage of the psoas abscess and antibiotics and was discharged home to complete a 6 week course of IV antibiotics.

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