A 56-year-old man with recently treated urosepsis and renal stones reported midthoracic pain followed within 10 days by numb feet and spastic gait. Previously he had had an L5-S1 hemilaminectomy. He was afebrile, normotensive, and without spinal tenderness. Findings from neurologic examination revealed abdominal and quadriceps fasciculations, absent pinprick sensation below T6, and vibratory sense to the knees, absent ankle reflexes, and a spastic gait. Magnetic resonance imaging showed epidural thickening and enhancement around the thecal sac with a fluid collection posterolaterally from T7-T9, with spinal cord compression (Figure 1). Emergent surgery revealed pus at T8-T10, a culture of which grew Staphylococcus aureus. He was treated with vancomycin. Twelve hours after surgery gait and sensation were normal.
Tessman PA, Preston DC, Shapiro BE. Spinal Epidural Abscess in an Afebrile Patient. Arch Neurol. 2004;61(4):590-591. doi:10.1001/archneur.61.4.590