title: Spinal epidural abscess as a result of dissemination from gluteal abscess secondary to intramuscular analgesic injection.
abstract: Spinal epidural abscess is a collection of suppurative material that forms between the dura mater and the ligamentum flavum. If not recognized early and treated correctly, it can lead to life-threatening sepsis. Here we report the case of a female patient, 51 years of age, with difficulty walking and bilateral leg pain after having had degenerative discogenic pain for many years. The patient had occasionally received intramuscular non-steroidal anti-inflammatory drug injections. The current report is that of an unusual case of epidural abscess that formed following multiple dose of intramuscular non-steroidal anti-inflammatory drug over a 1-year period. Hematogenous or direct dissemination is the suspected cause. To prevent serious morbidity and mortality, early diagnosis is essential. Patients with localized back pain who are at risk for developing such epidural spinal abscesses should receive a magnetic resonance imaging scan with contrast enhancement without delay. The existence of predisposing factors such as intramuscular injections should be considered in the assessment of suspected spinal epidural abscess.
authors.affiliation: Neurosurgery Department, American Hospital, 34365 Nisantasi, Istanbul, Turkey. sasanim@gmail.com
authors.forename: Mehdi
authors.initials: M
authors.lastname: Sasani
authors.forename: Ozlem
authors.initials: O
authors.lastname: Aydin
authors.forename: Ahmet Levent
authors.initials: AL
authors.lastname: Aydin
authors.forename: Tunc
authors.initials: T
authors.lastname: Oktenoglu
authors.forename: Ali Fahir
authors.initials: AF
authors.lastname: Ozer
authors.forename: Omur
authors.initials: O
authors.lastname: Ercelen
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects*; D001416:Back Pain / Q000188:drug therapy; D020802:Epidural Abscess / Q000209:etiology*; D005260:Female; D005682:Gadolinium; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000150:complications; D013530:Surgical Wound Infection / Q000150:complications
chemical_list: D005682:Gadolinium