Primary erector spinae pyomyositis causing an epidural abscess: case report and literature review.
BACKGROUND
Primary pyomyositis (PM) is a rare bacterial infection of skeletal muscle usually restricted to tropical zones. Typically caused by Staphylococcus aureus, primary staphylococcal PM associated with an epidural abscess has not been reported before.


OBJECTIVE
We present the first case of staphylococcal PM associated with an epidural abscess.


METHODS
Case report.


METHODS
A 56-year-old woman.


METHODS
Clinical follow-up at 9 months.


METHODS
This 56-year-old woman presented with a sudden onset of left lumbar back pain and sciatica without prior illness. She was pyrexial on admission, with elevated inflammatory markers but with no obvious systemic source of sepsis.


RESULTS
Spinal magnetic resonance imaging and subsequent surgery revealed an erector spinae abscess causing an epidural abscess via the left L4/5 intervertebral foramen. Both back pain and sciatica were immediately improved postoperatively. Culture revealed S aureus as the sole organism sensitive to flucloxacillin. Intravenous therapy was converted to oral after 12 days once the erythrocyte sedimentation rate had normalized and she was asymptomatic. She remains asymptomatic and without clinical signs at the 9-month follow-up.


CONCLUSIONS
Spinal infection must always be considered when back pain and sciatica are associated with clinical signs of sepsis. We present the first case of staphylococcal PM associated with an epidural abscess.
Marshman
Laurence A G
LA
Department of Spinal Surgery, University Hospital of North Tees, Hardwick, Stockton, North Tees, TS19 8PE, United Kingdom. l.a.g.marshman@btinternet.com
Bhatia
Chandra K
CK
Krishna
Manoj
M
Friesem
Thai
T
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001416:Back Pain / Q000209:etiology; D019299:Decompression, Surgical; D020802:Epidural Abscess / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D005260:Female; D005436:Floxacillin / Q000627:therapeutic use; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000382:microbiology / Q000473:pathology*; D052880:Pyomyositis / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D013131:Spine / Q000382:microbiology / Q000473:pathology; D013203:Staphylococcal Infections / Q000382:microbiology / Q000473:pathology*
D000900:Anti-Bacterial Agents; D005436:Floxacillin