A 48-year-old man presented to the emergency department with complain of severe
neck pain and anterior
chest pain. Intermittent
fever in the recent 2 days was also noted. There is a track maker over his left side of neck. The laboratory examination showed
leukocytosis and high
C-reactive protein level. Urine
drug screen was positive for
opiate. Empirical
antibiotic administration was given. Blood culture grew gram-positive cocci in chain, and there was no vegetation found by heart echocardiogram. However, progressive weakness of four limbs was noted, and patient even cannot stand up and walk. The patient also complained of
numbness sensation over bilateral hands and legs, and lower abdomen. Acute urine retention occurred. We arranged magnetic resonance imaging survey, which showed evidence of inflammatory process involving the retropharyngeal spaces and epidural spaces from the skull base to the bony level of T5. Epidural inflammatory process resulted in compression of the spinal cord and bilateral neural foramen narrowing. Neurosurgeon was consulted. Operation with
laminectomy and posterior fusion with bone graft and internal fixation was done. Culture of
epidural abscess and 2 sets of blood culture all yielded
methicillin-sensitive Staphylococcus aureus. For
epidural abscess, the most common involved spine is lumbar followed by thoracic and cervical spine. Diagnosis and treatment in the drug abusers are still challenging because they lack typical presentation, drug compliance, and adequate follow-up and because it is hard to stop drug abuser habit. Significant improvement of neurological deficit can be expected in most spinal
abscess in drug abusers
after treatment.