Patient paralyzed after misdiagnosis of an epidural abscess

Case Overview

This case involves a sixty-year-old male patient who presented to the emergency room complaining of a six day history of neck pain radiating to his back and right shoulder. During a series of visits back-and-forth between the emergency room and his primary care doctor, no abnormalities were found on chest x-ray, shoulder x-ray, EKG, and MRI. He returned again to his primary care physician with the same complaints of severe pain in his neck and right shoulder. The pain had now extended to his right arm. The patient’s wife, who accompanied him to the doctor’s office, reported that he had been feeling disoriented at times and was experiencing a burning sensation while voiding. The primary care physician suspected that the patient was suffering from prostatitis and prescribed a course of Ciprofloxacin. The patient was compliant and took the medication as advised. However, he was an avid coffee drinker and subsequently exhibited heightened anxiety, due to the effects of Ciprofloxacin on caffeine. Additionally, he showed no improvement in symptoms after several days despite the antibiotics and returned to the hospital for further evaluation. An infectious disease specialist was consulted. The ID physician conducted several investigations and found the presence of Staphylococcus aureus in the patient’s blood work and suspected a possible lumbar spine infection. An MRI of the patient’s cervical and thoracic spines was ordered due to continued pain which now included neck and upper thoracic pain. The MRI of the cervical spine revealed an epidural abscess at C4-C6 levels requiring emergency surgery. After surgery the patient was ruled to be a permanent paraplegic.