Spinal epidural abscess (SEA) caused by Escherichia coli is an uncommon condition. It usually occurs secondary to urinary tract infection (UTI), following hematogenous propagation. Disruption of spinal anatomic barriers increases susceptibility to SEA. Although rarely, such disruption can take the form of lumbar spine stress fractures, which can result from even innocuous activity. Here, we describe a case of SEA secondary to UTI in a patient with pre-existing stress fractures of the lumbar spine, following use of an automated massage chair. Successful treatment of SEA consisted of surgical debridement and a six-month course of antibiotic therapy.
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Spinal epidural abscess post-ureteroscopy: a case report Stephanie N. Washington, David D. Kim, Luke F. Reynolds BMC Urology.2025;[Epub] CrossRef
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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.
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A Case Presenting with a Paraspinal Muscle Abscess Complicated by Suspected Iodoform Poisoning During Treatment Shunya Tamamine, Atsuyuki Kuro, Masayuki Nakano, Shuhei Matsunami, Hiroaki Sakurai, Sakurako Kunieda, Kenji Suzuki, Natsuko Kakudo International Journal of Surgical Wound Care.2025;[Epub] CrossRef
Spinal epidural abscess due to acute pyelonephritis Gianluca Scalia, Salvatore Marrone, Federica Paolini, Paolo Palmisciano, Giancarlo Ponzo, Massimiliano Giuffrida, Massimo Furnari, Domenico Gerardo Iacopino, Giovanni Federico Nicoletti, Giuseppe Emmanuele Umana Surgical Neurology International.2022; 13: 159. CrossRef
Primary Spinal Epidural Abscesses Not Associated With Pyogenic Infectious Spondylodiscitis: A New Pathogenetic Hypothesis Lorenzo Magrassi, Marco Mussa, Andrea Montalbetti, Marta Colaneri, Angela di Matteo, Antonello Malfitano, Anna Maria Simoncelli, Maria Grazia Egitto, Claudio Bernucci, Enrico Brunetti Frontiers in Surgery.2020;[Epub] CrossRef
The overall prognosis of acute pyelonephritis is good, but the infections by extended spectrum Ղ-lactamase (ESBL) producing Escherichia coli (E.coli) cause poor responses to empirical antibiotic treatment, and consequently increase mortality. ESBL can hydrolyze the antibiotics with a Ղ-lactam ring and confer resistance to oxyimino-cephalosporins and monobactams. If the patient shows poor responses to empirical antibiotics or severe septic conditions, physicians must switch the antibiotics to other antibiotics covering resistant strains without delay. We report a case of acute pyelonephritis by extended-spectrum Ղ-lactamase producing E.coli in a 29-year-old woman who was empirically treated with oral ciprofloxacin as an initial treatment, but progressed to sepsis.
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