title: Diagnostic dilemma of sacral abscess presented with seizure and altered conscious level in a patient with spinal cord injury.
abstract: Infection and septicaemia may clinically presented with seizure and altered conscious level. In spinal cord injury (SCI) population, they are at risk of having pressure ulcer which can be complicated further with infection and septicaemia.
  
  
  
  A 40-year-old man with complete T4 SCI and multiple clean and non-healing pressure ulcers at sacral and bilateral ischial tuberosity regions was initially admitted for negative pressure wound therapy (NPWT) dressing. He had an episode of seizure and subsequently had fluctuating altered conscious level before the diagnosis of deep-seated sacral abscess was made and managed. Prior investigations to rule out common possible sources of infections and management did not resolve the fluctuating event of altered consciousness.
  
  
  
  We presented an unusual case presentation of septicemia in a patient with SCI with underlying chronic non-healing pressure ulcer. He presented with seizure and fluctuating altered conscious level. Even though a chronic non-healing ulcer appeared clinically clean, a high index of suspicion for deep seated abscess is warranted as one of the possible sources of infection, especially when treatment for other common sources of infections fails to result in clinical improvement.
authors.affiliation: a Department of Rehabilitation , Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia.
authors.forename: Kelvin Cheng
authors.initials: KC
authors.lastname: Chek Siang
authors.affiliation: a Department of Rehabilitation , Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia.
authors.forename: Aishah
authors.initials: A
authors.lastname: Ahmad Fauzi
authors.affiliation: a Department of Rehabilitation , Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia.
authors.forename: Nazirah
authors.initials: N
authors.lastname: Hasnan
mesh_terms: D000038:Abscess / Q000150:complications / Q000175:diagnosis*; D000328:Adult; D003244:Consciousness Disorders / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D012447:Sacrum / Q000473:pathology*; D012640:Seizures / Q000150:complications / Q000175:diagnosis*; D013119:Spinal Cord Injuries / Q000150:complications*
keywords: Pressure ulcer; Sacral abscess; Septicaemia; Spinal cord injury