Resolution of group B streptococcal panspinal epidural abscess in a patient with diabetes after treatment with ceftriaxone and linezolid

Abstract

Panspinal epidural abscesses are an extremely rare yet potentially fatal condition. Whether cases are best managed surgically or medically is currently controversial. A 63-year-old patient with diabetes presented initially with abdominal pain, back pain, urinary retention and constipation. He subsequently developed fevers, radicular pain and new-onset weakness in the right leg. MRI confirmed a panspinal epidural abscess extending from C7 to L5, with group B Streptococcus (GBS) cultured on sampling. Due to the significant risks of surgery he was managed conservatively, initially with ceftriaxone, and subsequently in combination with linezolid. Repeat MRI 3 months after presentation revealed complete resolution of the abscess. This case illustrates how conservative management is a valid option for patients with this condition, and supports the use of synergistic linezolid in this scenario. It also highlights how some cases may not initially present with the classically described triad of fever, back pain and loss of neurological function.