Tuberculous spinal epidural abscess: a cautionary case report of permanent paraplegia due to delayed diagnosis and management

Spinal epidural abscess caused by tuberculosis is a rare but serious complication of spinal tuberculosis. Its atypical presentation predisposes to diagnostic delay and a poor prognosis. This case not only documents the clinical and radiologic evolution of tuberculous spinal epidural abscess but also suggests that delays in diagnosis and treatment may jointly contribute to serious neurological outcomes. A 39-year-old man initially underwent acupotomy for recurrent low back pain with recent exacerbation. Subsequent imaging revealed a paraspinal abscess within the erector spinae muscle. Ten days later, the abscess was drained. However, the patient experienced rapidly progressive neurological deficits, including bilateral lower limb weakness. Magnetic resonance imaging revealed long-segment epidural granulation tissue compressing the spinal cord, and etiological testing confirmed tuberculosis infection. Due to prolonged delays in diagnosis and surgical decision, the patient remained paraplegic for five days before being transferred to our hospital, where he underwent spinal canal decompression and debridement. Nevertheless, permanent paraplegia persisted after the intervention. For patients with intractable back pain of suspected spinal origin, early Magnetic resonance imaging is recommended to rule out spinal epidural abscess and to assess the necessity of surgical intervention. Once neurological deficits develop, early diagnosis, timely surgery, and appropriate anti-tuberculosis therapy are key to improving outcomes in patients with tuberculous spinal epidural abscess. The prognosis for patients with rapidly progressive, complete paraplegia is generally poor.