Spinal Epidural Abscess in an Infant Presenting as Fever and Respiratory Distress

Abstract

A 9-month-old healthy female presented during winter to the emergency department with a chief complaint of fever and prominent respiratory symptoms. She was discharged on oseltamivir with a presumptive diagnosis of influenza. She returned to the emergency department 2 days later with continued fever and more upper respiratory symptoms. She was admitted for intravenous hydration to the observation unit with a diagnosis of viral illness (with viral testing that returned positive for adenovirus) and dehydration. When her high fevers continued, bloodwork that was concerning for leukocytosis, elevated inflammatory markers, and elevated alkaline phosphatase was obtained. During her workup for fever, a full body magnetic resonance imaging was performed, which revealed the diagnosis of a C3 to L5 spinal epidural abscess. This case demonstrates the difficulty of making this important diagnosis in a preverbal child presenting with a concurrent virus during winter viral season.

Acute Paraplegia Caused by Spinal Epidural Empyema Following Infectious Cellulitis of the Hand: Case Report and Literature Review

“… 23 Enhanced MRI is still considered the preferred imaging study for confirming the diagnosis of SEA, which is most commonly found in the thoracic region (48%), followed by the lumbar region (31%) and the cervical region. 29 30 31 32 33 As evidenced in Table 1 , the SEA involved multiple vertebral levels; the region of the thoracic vertebrae was affected in 50%, the lumbar region in 50%, and the cervical region in 27.7%.…”