Pyomyelia presenting as acute flaccid paralysis

We report an unusual case of a 10-month-old girl with intramedullary spinal cord abscess who presented with fever and acute flaccid paraplegia. Nerve conduction study showed demyelinating neuropathy after which she received intravenous immunoglobulin therapy. This was followed by ascending paralysis and left-sided ptosis. Lumbar puncture revealed purulent cerebrospinal fluid and magnetic resonance imaging (MRI) with gadolinium showed intramedullary holocord abscess with a dermal sinus tract extending from skin to intramedullary canal in the lumbosacral region. This tract was excised completely along with drainage of pus. She was treated with broad-spectrum antibiotics for 6 weeks and underwent neurorehabilitation after which there was significant neurological improvement. Follow-up MRI shows good resolution of the intramedullary abscess.