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Holocord spinal epidural abscess in a pregnant patient presenting as premature labour: a rare presentation of an unusual diagnosis

Published online by Cambridge University Press:  04 March 2015

Kirsteen R. Burton ,
Xi Wang  and
Deljit Dhanoa
Kirsteen R. Burton*
Affiliation:
Institute of Health, Policy, Management and Evaluation Medical Imaging, University of Toronto, Toronto, ON Biostatistics, University of Toronto, Toronto, ON
Xi Wang
Affiliation:
Department of Diagnostic Radiology, McMaster University, Hamilton, ON
Deljit Dhanoa
Affiliation:
Medical Imaging, University of British Columbia, Fraser Health Authority, Vancouver, BC
*
Department of Radiology, Faculty of Medicine, University of British Columbia, 3350-950 W 10th Avenue, Vancouver BC V5Z 4E3; dhanoad@yahoo.com

Abstract

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Spinal epidural abscess (SEA) is a rare clinical entity. It is less common when the entire epidural space is involved, known as a holocord or panspinal SEA, and it is even less common in a pregnant patient. We report a case of methicillin-resistant Staphylococcus aureus holocord SEA in a 30-year-old female at approximately 22 weeks' gestational age who presented with lumbar pain and pelvic pressure and the urge to bear down. Magnetic resonance imaging of the spine demonstrated extensive SEA and meningitis from the foramen magnum to the lumbar spine that was treated both medically and surgically. The incidence of, clinical presentation of, and risk factors for developing SEA are discussed. If untreated, expanding SEAs produce sensory symptoms and signs, motor dysfunction, and, eventually, paralysis and death. The medical and surgical management of SEA is also discussed. SEA can have an insidious and atypical presentation despite extensive involvement of the epidural space. Therefore, the diagnosis of SEA should always be considered in patients who present to the emergency department with back pain.

Keywords

back painemergencyepidural abscessmagnetic resonance imagingmethicillin-resistantStaphylococcus aureusosteomyelitispregnancy
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 4 , July 2014 , pp. 334 - 338
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

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