Chest pain as presenting symptom of Staphyloccocus aureus epidural abscess associated with anti-tumor necrosis factor and methotrexate therapy.

A case of staphylococcal epidural abscess associated with infliximab and methotrexate therapy in a patient with psoriatic arthropathy is presented. He presented atypically with chest pain, on a background of long standing history of neck pain, and rapid progression to complete paraplegia. Clinicians should be aware that invasive staphylococcal infections are associated with biologic and disease modifying antirheumatic drug therapy, and these may present atypically and be rapidly progressive. Initial empiric antimicrobial therapy including staphylococcal coverage should be considered in the appropriate clinical context in acutely ill patients who are on these agents, along with prompt surgical intervention where appropriate.