Unusual presentation of a spinal epidural abscess.

A 59-year-old female patient presented with a 3-day history of abdominal pain and confusion. She had no significant medical history. On admission her Glasgow Coma Scale was 14/15; she was septic and examination revealed right upper quadrant tenderness. She deteriorated quickly, becoming acidotic and hypoxic, and was sedated, intubated and transferred to the intensive care unit. Blood tests revealed raised inflammatory markers and blood cultures grew Staphylococcus aureus. Initial CT head revealed raised intracranial pressure and she was treated for meningoencephalitis. Repeat CT head 12 days later showed resolving oedema, and a lumbar puncture was attempted. This drew only frank pus and an abscess was suspected. CT spine confirmed a possible paravertebral abscess. Once extubated, MRI spine was possible which confirmed spinal epidural abscesses-1 month postadmission. These were rapidly drained by the neurosurgical team and the patient is currently receiving rehabilitation in a specialist centre.