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Para-spinal abscess presenting with abdominal pain—a case report of ‘red herring’ symptoms

Spinal Cord Series and Cases volume 9, Article number: 38 (2023) Cite this article

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Abstract

Introduction

Paraspinal abscesses are rare infections affecting the paraspinal muscles and soft tissues. An evolving abscess may pose a threat to the spinal cord via the compressive effect which can manifest as impaired motor or sensory function at the corresponding vertebral level. Paraspinal abscess is often a late diagnosis due to non-specific symptoms at presentation. This results in high morbidity and mortality.

Case presentation

We describe the case of a 59-year-old female with a paraspinal abscess presenting with epigastric pain who was initially worked up for a suspected intra-abdominal pathology, however computerised tomography of the chest, abdomen, and pelvis (CTCAP) revealed no abnormality. Later, rising inflammatory markers, accompanied by worsening cervicalgia, prompted a CT of the head, neck and thorax which revealed a soft tissue abscess compressing the thecal sac at cervical levels 1 to 3 (C1-3). This was successfully managed with radiologically guided drainage and long-term intravenous antibiotics. Our patient made a full recovery and a repeat MRI demonstrated resolution of the abscess.

Conclusion

We demonstrate that spinal abscess can present with a misleading combination of symptoms and highlight the importance of considering rarer differentials in the face of an evolving clinical picture. Our case also demonstrates that once the correct diagnosis is reached, patients can make an excellent recovery from uncomplicated spinal abscesses.

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Fig. 1: CT axial imaging of the left-sided paraspinal collection.
Fig. 2: CT sagittal imaging of the left-sided paraspinal collection.
Fig. 3: Gadolinium contrast-enhanced MRI axial imaging of the left-sided paraspinal abscess.
Fig. 4: Gadolinium contrast-enhanced MRI coronal imaging of the left-sided paraspinal abscess.
Fig. 5: Timeline.

Data availability

All data generated or analysed during this study are included in this published article. Additional data are available from the any of the three authors on reasonable request.

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Acknowledgements

MV takes responsibility for the content of the manuscript, including the case assemblage, description and literature review. JL and FD provided mentorship and guidance, editorial input and constructive review during the writing of this case.

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Author notes

  1. These authors contributed equally: James Livingstone, Farzan Dholoo.

Authors and Affiliations

  1. St Peter’s Hospital, General Surgery Department, Guildford St, Lyne, Chertsey, KT16 0PZ, UK

    Mayya Vorona, James Livingstone & Farzan Dholoo

Authors
  1. Mayya Vorona
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  2. James Livingstone
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  3. Farzan Dholoo
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Contributions

MV was responsible for seeking the informed consent of the patient, following and documenting the patient’s clinical journey, compiling the case, literature review. The images were selected in a collective session with all authors present. JL drafted the introduction, JL and FD collectively provided continual revisions and improvements to the manuscript, and guided the layout.

Corresponding author

Correspondence to Mayya Vorona.

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The authors declare no competing interests.

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Vorona, M., Livingstone, J. & Dholoo, F. Para-spinal abscess presenting with abdominal pain—a case report of ‘red herring’ symptoms. Spinal Cord Ser Cases 9, 38 (2023). https://doi.org/10.1038/s41394-023-00598-y

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  • DOI: https://doi.org/10.1038/s41394-023-00598-y

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