title: Primary erector spinae pyomyositis causing an epidural abscess: case report and literature review.
abstract: 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.
authors.affiliation: Department of Spinal Surgery, University Hospital of North Tees, Hardwick, Stockton, North Tees, TS19 8PE, United Kingdom. l.a.g.marshman@btinternet.com
authors.forename: Laurence A G
authors.initials: LA
authors.lastname: Marshman
authors.forename: Chandra K
authors.initials: CK
authors.lastname: Bhatia
authors.forename: Manoj
authors.initials: M
authors.lastname: Krishna
authors.forename: Thai
authors.initials: T
authors.lastname: Friesem
mesh_terms: 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*
chemical_list: D000900:Anti-Bacterial Agents; D005436:Floxacillin