Spontaneous Multiloculated Lumbar Abscess in a Middle-Aged Male With Unexplained Progressive Back Pain and Muscle Weakness

A 54-year-old man with a past medical history significant for sciatica, as well as multiple orthopedic surgeries with hardware, was transferred from an outside rural facility for further workup of a two-month history of progressive back pain and muscle weakness. Investigations ultimately revealed abnormal enhancement from T11 to sacrum, with a large epidural abscess from L5 to the sacrum, best visualized on an MRI. Following the MRI confirmation of loculated complex thoracolumbar abscess, neurosurgery performed a left L3-S1 unilateral laminotomy and evacuation of compressive multiloculated epidural abscesses. The patient was then treated with empirical antimicrobial coverage for epidural abscess with vancomycin and ceftriaxone, which was narrowed to cefazolin based on positive methicillin-susceptible Staphylococcus aureus (MSSA) wound cultures obtained in the operating room. The patient completed a total six-week course of antibiotic therapy. Apart from some superficial wound dehiscence postoperative, the patient ultimately recovered well and had a resolution of most presenting symptoms.