Spontaneous spinal epidural abscesses are rare and often present high mortality due to late diagnosis. Spinal epidural abscesses are mainly formed by spondylodiscitis, osteomyelitis, hematogenous dissemination, or by local manipulation (surgery or epidural catheter placement). Recommended treatment is surgical medullar decompression followed by targeted antibiotic therapy.
Authors document a case of a 51-year-old female, smoker, with bipolar disease and a recent hospitalization due to pneumonia. She was treated with antibiotic therapy with complete resolution of symptoms and laboratory abnormalities. After discharge, she reports periodic fever episodes, with no identified focus and not valued by her. About a month later, sudden paraparesis occurred, and an epidural abscess was diagnosed and it was submitted to surgical drainage. After spinal decompression, she underwent antibiotic therapy for twelve weeks with complete neurological recovery. Although uncommon, spinal epidural abscesses may be formed by contiguity lesions in the pleural space.
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