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Spinal epidural abscess — SCE Acute Medicine MCQ

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HardInfectious diseasesSpinal epidural abscessSCE Acute Medicine

A 64-year-old man is admitted with fever and back pain. He had Staphylococcus aureus bacteraemia from a cannula infection one week ago and left hospital early. He now has new leg weakness, urinary retention and percussion tenderness over T8. CRP is 220 mg/L. What is the most appropriate investigation?

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Correct answer: D — Urgent MRI whole spine

Back pain with fever, recent S. aureus bacteraemia, neurological deficit and urinary retention suggests spinal epidural abscess with cord compression. Urgent MRI whole spine is the investigation of choice and must not be delayed. Lumbar puncture risks deterioration and does not identify the compressive lesion.

Reference: NICE NG234; IDSA Vertebral Osteomyelitis Guidance