Patient Develops Sepsis From Undiagnosed Spinal Abscess

This case involves an elderly woman in Mainewith a past medical history of lumbar surgery, who presented to the emergency room with complaints of extreme pain. While the patient was in the emergency room she was given a number of painkillers, however the medication had no apparent effect on her pain. Due to her distress, the patient was admitted. Shortly after admission, the patient began to manifest a fever, as well as localized pain and tenderness of her lower back. The patient was scheduled for spinal surgery intended to treat her pain, and as a result underwent pre-operative examinations and testing. Initial testing revealed no abnormalities, however later testing began to show highly elevated white blood cell counts. A bacterial culture later revealed the presence of bacteria in her bloodstream. Eventually, the patient was diagnosed with sepsis and died in the hospital.

Question(s) For Expert Witness

1. How often do you care for similar patients?

2. What are the risk factors for an epidural abscess?

3. What are the signs and symptoms of spinal epidural abscess?

4. What tests are required to make the diagnosis?

Expert Witness Response E-043492

I am an active infectious diseases clinician and it is not unusual for me to care for a patient with a spinal epidural abscess once or twice each month while I'm performing consultations in the hospital. SEAs are typically due to hematogenous seeding of the tissues or direct extension of infection. Persons at greater risk for bacteremia are at greater risk for SEA (e.g., immunocompromised persons, diabetics and those with infections such as endocarditis). Extensions of infections such as diskettes, diverticulitis can also lead to SEAs as can injection into the spine with contaminated substances or injection of contaminated illicit or prescribed drugs. Signs and symptoms typically include fever, increased white blood cell count, and back pain. An MRI showing a paraspinal fluid collection followed by aspiration of purulent fluid from the collection and a culture positive for bacteria is the gold standard for diagnosis. I am board certified in adult and pediatric infectious diseases and I am the medical director for infection prevention at one of the largest academic medical centers in the US. While I have not published or written specifically about SEA, I have cared for many patients (at least dozens) and have taught medical students, residents and infectious diseases fellows about SEA.