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We read with interest the letter by Pérez-Calvo et al. Their two cases of Brucella spinal epidural abscess are the first, we believe, described in the English-language literature.
It is noteworthy that they treated both cases without surgical intervention. We emphasize that, while successful medical therapy has been reported, radiculopathy, weakness, and paralysis may develop within hours in spinal epidural abscess, and they may be irreversible. Frequent neurological monitoring is necessary, and surgical decompression should be performed if symptoms advance. Serial magnetic resonance images may be used to monitor the resolution of the abscess with medical therapy.
Maslen D. Epidural Abscess due to Acute Brucella melitensis Infection-Reply. Arch Intern Med. 1994;154(12):1410-1411. doi:10.1001/archinte.1994.00420120142016