Spontaneous extensive spinal epidural abscess presenting as acute quadriparesis.

To cite: Verma R, Chaudhari TS, Lachuriya G. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2014-204892 DESCRIPTION An extensive spinal epidural abscess (SEA), sometimes referred to as a panspinal or holocord SEA, is a rare neurosurgical emergency. We present an interesting case of spontaneous extensive SEA that was managed with multilevel laminectomy along with intravenous antibiotics. A 35-year-old-man presented with high-grade fever and excruciating backache of 20 days duration, quadriparesis for 3 days and respiratory distress a day before admission. Quadriparesis evolved symmetrically over 24 h, initially affecting the lower extremities followed by upper extremities within few hours. There was no history of diabetes, trauma, intravenous drug abuse or any other medical comorbidity. On examination, his vital parameters were stable except for tachycardia and tachypnoea. Neurological examination revealed sensory motor quadriparesis with C4 sensory level and extensor plantar response. Power was grade 0 in the lower limbs and grades 1–2 in the upper limbs. Routine blood investigations were normal and did not reveal any comorbid disorder. HIV ELISA was negative. MRI of the spine revealed extensive epidural collection from C4 to L5 vertebral levels along with hyperintensity and cord enlargement in the cervical region from C4 to C7 on T2-weighted image (figure 1 A–F). Urgent neurosurgical intervention in the form of multiple level laminectomy from C7 to T8 levels and in the lumbar region was performed. Examination of drained pus revealed coagulase-negative staphylococci. The patient was treated with intravenous antibiotics for 4 weeks. At 6-week follow-up, there were no constitutional symptoms and power improved from grades 0 to 3. An extensive SEA is rare and usually occurs in immunocompromised hosts, patients with disruption of the spinal column, diabetes or in the presence of septic focus. 2 Our patient lacked any such risk factors. Hence, we labelled it as spontaneous SEA. Such spontaneous extensive SEAs have been