TITLE:
Spinal Epidural Abscess in Patients with Sepsis Who Experienced Significant Improvements after Complete Paralysis: Two Case Reports
AUTHORS:
Tomofumi Ogoshi, Motoo Yoshimiya, Hiroshi Ichibakase, Takayoshi Kimura, Masafumi Kameoka, Hayato Yoshioka, Takahiro Ueda, Masato Homma
KEYWORDS:
Antibacterial Agents, Diabetes Mellitus, Iatrogenic Abscesses, Infection, Spinal Epidural Abscess
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.8 No.4,
December
28,
2020
ABSTRACT: Spinal epidural abscess (SEA) is a rare condition, and a delay in its diagnosis causes paralysis. In this study, we report two rare cases of delayed diagnosis of SEA whose conditions improved after a state of complete paralysis. The first case was a 71-year-old diabetic man who received a corticosteroid injection for shoulder pain that caused intensified pain. Thereafter, the patient developed paralysis of both legs in stage IV according to Heusner staging. Subsequently, he was diagnosed with multiple abscesses and sepsis. He was in a poor state of health. Therefore, we treated his epidural abscess conservatively. After a month, his muscle strength had improved to Heusner stage III-A, and he was transferred to another hospital. The second case was a 64-year-old diabetic man who received an epidural corticosteroid injection for lower back pain. However, the pain intensified and was admitted to the hospital for pyelonephritis. He developed paralysis in both of his arms and legs presenting as a Heusner stage IV, caused by a cervical epidural abscess. A laminoplasty was performed and paralysis was improved. However, the patient subsequently developed a left subcortical hemorrhage. He underwent surgery. However, his right hemiplegia persisted, and on Day 21, he was transferred back to the previous hospital with a Heusner III-A. We could improve the patients’ paralysis by cooperating closely with infectious disease specialists and spine surgeons, taking intensive care, applying antibacterial agents appropriately, and operating quickly.