Case Report: Magnetic Resonance Imaging in the Diagnosis of Epidural Abscess Complicating Perirectal Fistulizing Crohn's Disease

Abstract

Epidural abscess is a rare complication of fistulizing Crohn's disease (CD), potentially appearing as neurologic symptoms or back and leg pain. We report a case of a large epidural abscess resulting from uncontrolled fistulizing CD, which was rapidly defined using gadolinium-enhanced magnetic resonance imaging (MRI). Whenever caudal neurologic symptoms, back pain, and fever arise in CD patients, diagnostic MRI of the pelvis in addition to conventional computerized tomography should be considered to identify perirectal fistulization to the spine.

Long-term Functional Outcome in Pyogenic Spinal Infection

“…4 Association of spinal infection with ulcerative colitis, seen in 2 patients, is only previously recorded in isolated case reports. 26,27 Both patients were receiving corticosteroid therapy at the time of diagnosis. The organism cultured in both cases was Staphylococcus aureus.…”

Serratia Marcescens Spinal Epidural Abscess Formation Following Acupuncture

“…Epidural abscess is an uncommon complication of acupuncture that may present with neurologic symptoms, including back and leg pain and numbness (1). Serratia marcescens is rarely reported to be a pathogen of invasive diseases in patients with acupuncture-treated low back pain.…”

“…The lesion was quickly diagnosed using T1-weighted gadoliniumenhanced magnetic resonance imaging (MRI). In acupuncture patients with neurologic symptoms, such as back pain, a root sign and fever, performing diagnostic MRI of the lumbar spine may help to identify peripsoas and spinal epidural abscess (1). To date, this is the first case of invasive Serratia marcescens-related spinal epidural abscess formation in a patient without previous medical comorbidities who underwent acupuncture (2).…”

Epidural abscess secondary to acute appendicitis

“…While epidural collections directly extending from intraabdominal sources have previously been reported secondary to fistulating Crohn's disease, [1][2][3] duodenal ulceration 4 and colospinal fistula following rectal surgery and radiotherapy, 5 to our knowledge this is the first reported case of appendicitis as the underlying cause. In this case infection appears to have spread contiguously through sacral vertebral bodies into the epidural space.…”