Spinal Epidural and Subarachnoid Abscess Due to Acute Pyelonephritis in a 56-Year-Old Woman: A Case Report and Literature Review

With recent advances in treatment technology, the mortality rate of spinal abscesses is decreasing. However, spinal abscesses are still unusual and difficult to treat. A 56-year-old woman presented with lower back pain and fever and chills that started two days before the visit. Initially, she showed lower limb extremity motor weakness. There was right focal acute pyelonephritis of the upper kidney portion with an associated complicated cyst on abdominal-pelvic computed tomography. Klebsiella pneumoniae was cultivated in blood and urine cultures. Spine magnetic resonance imaging with contrast enhancement was completed and the results showed epidural and subarachnoid space abscess formation in the whole lumbar space. The patient was treated with total laminectomy at L2-3 and laminotomy at L4-5 with epidural and subarachnoid abscess removal. After surgery, her back pain subsided enough that intravenous morphine was no longer needed. However, lower limb extremity motor weakness was not recovered. Antibiotics were administered to treat a potential cerebral nervous system infection for nine weeks. At the last follow-up, inflammation levels were normalized and the motor weakness in both legs was also normalized with active rehabilitation. This report described an epidural and subarachnoid abscess in a middle-aged woman due to urinary tract infection sepsis associated with acute pyelonephritis caused by Klebsiella pneumoniae. With proper surgery and adequate antibiotic treatment, the patient's symptoms improved significantly without any complications.