A 45-year-old man with a history of untreated
diabetes mellitus had a persisting
fever,
back pain, and
diarrhea. The primary care physician diagnosed the patient with the flu and
gastroenteritis. The patient developed
paraplegia for two weeks and was admitted to another hospital. The physician in this hospital suspected infectious
meningitis and
myelitis, and administered
piperacillin and
steroids without cerebrospinal fluid (CSF) examination. On referral to our hospital, he presented a high
fever and complete
paraplegia. The lumbar puncture revealed a yellowish CSF, polynucleosis, and hypoglycorrhachia. Bacteria were not detected on Gram's staining and were not confirmed by CSF culture. Magnetic resonance imaging (MRI) showed no thoracolumbar lesion and suggested a cervical
epidural abscess without any
spinal cord compression. He was diagnosed as having
osteomyelitis with
meningitis and thoracic
myelitis. The
infection subsided with broad-spectrum
antibiotics. After two weeks, bilateral sensorimotor disturbances of the upper extremities appeared. MRI findings showed the
epidural abscess compressing the cervical spinal cord. We performed
debridement of the
epidural abscess. The
infection was clinically controlled by using another
antibiotic. One month after the
infection subsided, a 360° reconstruction was performed. In this case, the misdiagnosis and the absence of CSF examination and culture to detect the pathogenic bacteria at an earlier stage in the patient's disease course might have led to the exacerbation of the pathology.