Development of Epidural and Paraspinal Abscesses after Insufficient Evaluation and Treatment of Acute Pyelonephritis Caused by Staphylococcus aureus.
Diagnoses of pyelonephritis caused by Staphylococcus aureus should be accompanied by investigations of concomitant bladder obstruction and metastatic infections, especially to the spine or heart. Complicated pyelonephritis due to S. aureus requires more than 2 weeks of antibiotics, which is the typically recommended treatment duration for pyelonephritis. We describe a patient who was diagnosed with complicated epidural and paraspinal abscesses after insufficient evaluation and treatment of acute pyelonephritis due to S. aureus. A 62-year-old man with type 2 diabetes was admitted with fever, increased urinary frequency, and left flank pain. He was diagnosed with acute pyelonephritis caused by S. aureus. His fever and flank pain subsided after 3 days of intravenous antibiotics. Evaluation of bladder obstruction and metastatic infection were not performed, as he declined further evaluation. The patient was discharged with oral antibiotics and was requested to attend weekly appointments but was lost to follow-up. One month later, the patient presented at the outpatient clinic with similar symptoms. Computed tomography showed recurrent pyelonephritis and a distended bladder. His flank pain persisted despite administration of an opioid agent. Therefore, magnetic resonance imaging was performed, revealing epidural and paraspinal abscesses. Ultrasound-guided aspiration of the paraspinal muscle layer was performed, and blood and percutaneous aspirated fluid cultures revealed S. aureus growth. The pattern of antimicrobial sensitivity was identical to that at his first admission. Following more than 4 weeks of antibiotics, magnetic resonance imaging showed the abscesses had decreased in size. The patient was discharged without neurologic sequelae and was provided with oral antibiotics.
Division of Nephrology, Department of Internal Medicine, Inseong Hallym Hospital, Incheon, Korea.
Mi Jeoung
MJ
Kim
Division of Nephrology, Department of Internal Medicine, Inseong Hallym Hospital, Incheon, Korea.
Hyang Mo
HM
Koo
Division of Infectious Diseases, Department of Internal Medicine, Inseong Hallym Hospital, Incheon, Korea.
Woo Joo
WJ
Lee
Department of Neurosurgery, Inseong Hallym Hospital, Incheon, Korea.
Jin Hwan
JH
Choi
Department of Radiology, Inseong Hallym Hospital, Incheon, Korea.
Mi Nyong
MN
Choi
Department of Internal Medicine, Inseong Hallym Hospital, Incheon, Korea.
Sang Young
SY
Park
Department of Internal Medicine, Inseong Hallym Hospital, Incheon, Korea.
Woo Jung
WJ
Kim
Division of Nephrology, Department of Internal Medicine, Gimpo Woori Hospital, Gimpo, Korea.
Seung Yeon
SY
Son
Epidural Abscess; Pyelonephritis; Staphylococcus aureus; Urinary Tract Infections
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