Thoracic spinal epidural abscess caused by fishbone perforation

RATIONALE Ingestion of a fishbone is a common cause of esophageal injury, but spinal epidural abscess (SEA) is a rare condition due to the esophageal penetration by a swallowed fishbone. Prompt diagnosis can be seldom made owing to incomplete patient history taking and difficulties in imaging evidence identification. PATIENT CONCERNS We describe the case of a 62-year-old woman who was stuck in her throat by a fishbone, and complained of back pain, paresis of the lower limbs and fever, successively. To our knowledge, this is the first case report that we know of thoracic SEA caused by fishbone perforation. DIAGNOSES About 20 days after the onset of severe back pain, she was diagnosed with SEA based on the clinical presentation and imaging findings. INTERVENTIONS Antibiotic therapy and rehabilitation therapy were carried out afterwards. However, due to exacerbation of her condition, surgical intervention had to be taken eventually. OUTCOMES It is quite unfortunate for this patient to have a poor prognosis due to a delayed diagnosis and an improper management. LESSONS A number of lessons can be learnt from this case.