Case Report
Epidural Abscess and Meningitis After Epidural Corticosteroid Injection

https://doi.org/10.4065/79.5.682Get rights and content

Epidural abscess with and without associated meningitis after epidural corticosteroid injections for radicular back pain is a rarely reported complication. We report the occurrence of an epidural abscess and meningitis in a 70-year-old man after 2 epidural corticosteroid injections for treatment of acute radicular lumbar back pain. At the time of diagnosis, cerebrospinal fluid cultures grew Staphylococcus aureus, and the patient was treated with intravenous antibiotics. Possible predisposing factors for the development of an epidural abscess and meningitis in this patient include a 2-year history of neutropenia and an accidental dural puncture that occurred during performance of the first epidural injection. A literature search identified 11 reported cases of epidural abscess, 2 of epidural abscess and meningitis, and 1 of meningitis attributed to epidural corticosteroid injections. Eight of the 14 reported patients were immunocompromised, and 8 (67%) of the 12 in whom cultures of blood, cerebrospinal fluid, or epidural pus were performed had results positive for S aureus. Antibiotic prophylaxis for S aureus should be considered for immunocompromised patients undergoing epidural corticosteroid injections.

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REPORT OF A CASE

A 70-year-old man developed acute left hip and thigh pain after sustained heavy lifting. His medical history was remarkable for a 2-year history of leukopenia, with an absolute neutrophil count of less than 1.0 × 109/L while taking hydroxychloroquine for treatment of inflammatory polyarthritis.

Three weeks after the onset of pain, an outpatient evaluation by his primary care physician identified tenderness overlying the left trochanteric bursa. Left trochanteric bursitis was diagnosed, and the

DISCUSSION

We reviewed the literature to identify predisposing epidemiological and clinical features of patients in whom epidural abscesses or meningitis developed after epidural corticosteroid injections. Our goal was to compare and contrast the findings in the reported cases with the clinical course of our patient. A MEDLINE and EMBASE literature search identified 11 reports of epidural abscess and 2 reports of epidural abscess and meningitis. Another report6 described 2 patients with meningitis

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