Thoracic Spondylodiscitis Epidural Abscess in an Afebrile Navy Veteran: A Case Report

• Published in: Journal of chiropractic medicine 2017, Vol.16 (3), p.246-251
• Main Authors: Cupler, Zachary A, Anderson, Michael T, Stancik, Thomas J
• Format: Report
• Language: English
• ISSN: 1556-3707
• DOI: 10.1016/j.jcm.2017.03.002

OBJECTIVEThe purpose of this case study was to describe the differential diagnosis of a thoracic epidural abscess in a Navy veteran who presented to a chiropractic clinic for evaluation and management with acupuncture within a Veterans Affairs Medical Center. CLINICAL FEATURESAn afebrile 59-year-old man with acute thoracic spine pain and chronic low back pain presented to the chiropractic clinic at a Veterans Affairs Medical Center for consideration for acupuncture treatment. INTERVENTION AND OUTCOMEThe veteran elected to trial acupuncture once per week for 4 weeks. A routine thoracic magnetic resonance imaging scan without gadolinium detected a space-occupying lesion after the patient failed to attain 50% reduction of pain within 2 weeks with conservative care. The patient was diagnosed with a multilevel thoracic spondylodiscitis epidural abscess and was treated same day with emergency debridement and laminectomy of T7-8 with a T6-9 fusion. The patient had complete recovery without neurological compromise and completed an antibiotic regimen for 6 weeks. CONCLUSIONA Navy veteran with acute thoracic spine and chronic low back pain appeared to respond initially but failed to achieve clinically meaningful outcomes. Follow-up advanced imaging detected a thoracic spondylodiscitis epidural abscess. Early diagnosis and immediate intervention are important to preserving neurological function and limiting morbidity in cases of spondylodiscitis epidural abscess.