Diagnoses of
pyelonephritis caused by Staphylococcus aureus should be accompanied by investigations of concomitant bladder obstruction and metastatic
infections, especially to the spine or heart. Complicated
pyelonephritis due to S. aureus requires more than 2 weeks of
antibiotics, which is the typically recommended
treatment duration for
pyelonephritis. We describe a patient who was diagnosed with complicated epidural and paraspinal
abscesses after insufficient evaluation and treatment of acute
pyelonephritis due to S. aureus. A 62-year-old man with
type 2 diabetes was admitted with
fever, increased urinary frequency, and
left flank pain. He was diagnosed with acute
pyelonephritis caused by S. aureus. His
fever and
flank pain subsided after 3 days of intravenous
antibiotics. Evaluation of bladder obstruction and metastatic
infection were not performed, as he declined further evaluation. The patient was discharged with oral
antibiotics and was requested to attend weekly appointments but was lost to follow-up. One month later, the patient presented at the outpatient clinic with similar symptoms. Computed tomography showed recurrent
pyelonephritis and a distended bladder. His
flank pain persisted despite administration of an
opioid agent. Therefore, magnetic resonance imaging was performed, revealing epidural and paraspinal
abscesses. Ultrasound-guided aspiration of the paraspinal muscle layer was performed, and blood and percutaneous aspirated fluid cultures revealed S. aureus growth. The pattern of antimicrobial sensitivity was identical to that at his first admission. Following more than 4 weeks of
antibiotics, magnetic resonance imaging showed the
abscesses had decreased in size. The patient was discharged without neurologic sequelae and was provided with oral
antibiotics.