Spinal epidural abscess spinal cord compression causing neurological deficits in a patient without any trauma or immunosuppression: “Case Report”

Spinal epidural abscess (SEA) is a rare but serious condition that can rapidly progress to spinal cord compression and irreversible neurological deficits. We report the case of a 29-year-old previously healthy man who presented with acute thoracic back pain following physical exertion, which progressed to paraparesis, urinary retention, and ultimately tetraparesis. Magnetic resonance imaging revealed a posterior epidural collection extending from C5 to T2 with signs of compressive myelopathy. On hospital day 4, the patient underwent laminectomy and microsurgical drainage of the abscess. All microbiological cultures from blood, cerebrospinal fluid, surgical tissue, and other samples were negative, suggesting a sterile, inflammatory process. A purulent nasal lesion was considered a potential hematogenous source, although no pathogens were identified. The patient developed deep vein thrombosis and was started on anticoagulation therapy. Broad-spectrum empirical antibiotic therapy was administered for six weeks. Intensive motor rehabilitation led to gradual neurological improvement, including partial recovery of limb strength and of sphincter control. After 80 days of hospitalization, the patient was discharged with significant functional improvement. This case highlights the diagnostic challenge of SEA in the absence of classical risk factors or microbiological confirmation and emphasizes the critical importance of early imaging and timely surgical and medical management to prevent permanent disability in patients. • Patient with spinal cord compression at the cervico-thoracic transition due to a spinal epidural abscess, due to a probable infectious process that generated a severe neurological deficit in the patient with no history of trauma or immunosuppression. • Compression of the spinal canal at C5-T2 due to a probable infectious process that generated a severe neurological deficit, in this case sudden paresthesia and tetraparesis. • It is worth noting that patients with a late diagnosis (75% of them) are 6 times more likely to persist with neurological symptoms, unlike those with a brief diagnosis. • Almost all patients with abscesses have at least one risk factor.