The Commentaryīy Linnea Lantz, DO, Joseph Yoon, MD, and David Barnes, MD, FACEP The patient committed suicide several years later. He was unable to resume employment and required full-time home care after discharge. Despite surgical intervention, the patient remained quadriplegic. At that point, he was transferred to a tertiary care center where decompressive surgery was performed. Cervical magnetic resonance imaging (MRI) showed a spinal epidural abscess (SEA) adjacent to his surgical hardware.

After being called at home, the patient returned to the hospital and was admitted with a presumptive diagnosis of Staphylococcal meningitis.ĭespite initiation of intravenous antibiotic therapy, the patient developed worsening neurologic symptoms on his third hospital day including weakness, urinary incontinence, and urinary retention. The next morning, two blood cultures returned positive for Staphylococcus aureus while CSF culture was negative. He was diagnosed with viral meningitis and sent home with antiemetics and long-acting oral morphine sulfate. Cultures of blood and CSF were obtained but imaging of the cervical spine was not ordered. CSF obtained by lumbar puncture was cloudy with 692 white blood cells per microliter (80% neutrophils), low glucose, and high protein, but no visible organisms on Gram staining. He was sent to the ED by ambulance for suspected meningitis. He was next seen in the hospital's urgent care clinic where he had a fever of 101.4˚F, hallucinations, and neck stiffness. He returned to his primary care physician four days later with worsening headache, nausea, vomiting, and photophobia, and was given oxycodone for pain. Three days later, he presented to the emergency department (ED) with worsened headache and neck pain and was discharged without imaging or evaluation of cerebrospinal fluid (CSF). He was sent home from the clinic with advice to take over-the-counter analgesics. Laboratory testing showed only abnormal transaminases. On physical examination, his neck was tender, but he had no neurologic abnormalities. Identify multiple visits for the same complaint as a red flag that warrants broadening of differentials and avoidance of premature closureĪ 44-year-old man with a recent history of interferon treatment for Hepatitis C infection and a remote history of cervical spine surgery requiring permanent spinal hardware presented to his primary care physician with complaints of new onset headache, photophobia, and upper respiratory tract infection symptoms.Recognize pitfalls leading to erroneous interpretation of the tests for spinal epidural abscess.

Evaluate for spinal epidural abscess with laboratory testing and imaging.

List risk factors, symptoms, and exam findings associated with spinal epidural abscess.

Patrick Romano, MD, MPH Debra Bakerjian, PhD, APRN, RN Linnea Lantz, DO Joseph Yoon, MD David Barnes, MD Ulfat Shaikh, MD for this Spotlight Case and Commentary have disclosed no relevant financial relationships with commercial interests related to this CME activity.

The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as “any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients” and relevant financial relationships as “financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Authors, reviewers and others in a position to control the content of this activity are required to disclose relevant financial relationships with commercial interests related to the subject matter of this educational activity. Disclosure of Relevant Financial Relationships: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), the University of California, Davis, Health must ensure balance, independence and objectivity in all its CME activities to promote improvements in health care and not proprietary interests of a commercial interest.

Infection of the cervical spine x ray