Spinal epidural abscess in infants: Case report and review of the literature

Abstract

Spinal epidural abscess (SEA) is an uncommon but serious condition in children, where timely diagnosis is essential to avoid permanent neurological complications. Diagnosing SEA in pediatric patients, particularly in infants, is challenging due to nonspecific symptoms such as fever and pain, which are often difficult to interpret and can lead to delayed or missed diagnoses. This report details the case of a 10-month-old otherwise healthy infant with an extensive SEA, where fluorine-18 fluorodeoxyglucose PET/CT (F-FDG PET CT) was effectively used to confirm the diagnosis. Additionally, we conducted a comprehensive literature review from January 2000 to October 2024 to explore clinical presentations and imaging considerations unique to infants with SEA. Of the 124 cases reviewed, 13 met our inclusion criteria. The most common symptoms were fever and irritability, followed by motor deficits. The primary pathogen was MSSA, affecting the cervical spine in most cases, and the majority of infants received antibiotics, with most undergoing neurosurgical intervention, and no deaths were reported in the cohort. This case, along with the review, underscores the importance of early recognition and advanced imaging approaches in enhancing diagnostic accuracy and improving outcomes for pediatric SEA. F-FDG PET CT can be diagnostically useful in certain infant cases of occult bacteremia where no obvious infection source is identified.