Nocardial epidural abscess: A case report.

Few cases of primary Nocardial epidural abscesses have been reported in the literature over the past 50 years, with limited guidelines available for identification and management. Typically, cases involve a prior diagnosis of systemic Nocardiosis with resultant seeding of a disseminated infection to the spine. An adult with chronic low back pain and type 2 diabetes mellitus underwent three consecutive epidural steroid injections in an outpatient setting. The patient gradually developed diffuse bilateral lower extremity pain, acute urinary retention, and saddle paresthesia. Lumbar magnetic resonance imaging revealed central herniation with annular tear compressing the thecal sac and S1 nerve roots, a dorsal epidural hemorrhage, and an abscess causing severe canal stenosis at L4-L5 and L5-S1. The patient was treated with vancomycin, piperacillin-tazobactam, and methylprednisolone without improvement, ultimately requiring surgical decompression. Initial surgical cultures grew mycobacterium species prompting RIPE therapy. Symptoms continually worsened requiring repeat decompression. Final cultures grew

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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.