Panspinal Epidural Abscess

A 41-year-old man with recent intravenous drug use presented with 2 weeks of progressively worsening neck and low back pain, four days of bilateral upper and lower extremity weakness, and urinary retention. Magnetic resonance imaging (MRI) revealed a T2/STIR hyperintense posterior epidural collection, suggestive of a spinal epidural abscess (SEA), extending throughout the epidural space of the cervical, thoracic, and lumbar spine (Figure 1). Axial T2-weighted imaging revealed compression of the cord with associated intramedullary T2 hyperintensity (Figure 2A). Large fluid collections within the right paraspinal muscles (Figure 2B) and bilateral psoas muscles are consistent with additional soft tissue abscesses.