Epidural abscess associated with intravenous drug abuse in a pregnant patient.
The association between intravenous drug abuse and epidural abscess is well known; however, this association has not previously been reported in a pregnant patient. The classic manifestation of epidural abscess is a febrile patient with back pain that progresses rapidly to radicular pain, spinal cord dysfunction, weakness, and then complete paralysis. Although this condition is rare during pregnancy, these serious complications necessitate prompt diagnosis and intervention. If spinal infection is suspected, magnetic resonance imaging should be performed immediately. After epidural abscess is diagnosed, emergent decompressive laminectomy and appropriate antibiotic coverage are necessary. Herein we describe a 27-year-old pregnant patient with epidural abscess probably related to use of contaminated needles for intravenous administration of drugs and subsequent hematologic spread of staphylococci to the epidural space. The differential diagnosis of epidural abscess can be difficult, and management options must consider the well-being of both the mother and the fetus.
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905.
J T
JT
Van Winter
S N
SN
Nielsen
P L
PL
Ogburn
D000038:Abscess / Q000209:etiology*; D000328:Adult; D004824:Epidural Space; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications; D011251:Pregnancy Complications, Infectious; D013122:Spinal Diseases / Q000209:etiology*; D013203:Staphylococcal Infections; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013904:Thoracic Vertebrae