Widespread epidural abscess following bolus epidural block

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A 54-year-old woman developed neck pain, paresis and high-fever following epidural block. The epidural block was performed three times at a clinic within 2 weeks for treatment of low back pain attributable to a slipped 4th lumbar vertebral disc. Two hours after the last epidural block, neck stiffness was observed, and astasia-abasia appeared the next morning. On blood examination, an increase in WBC (13, 500/μl) and CRP (33.4mg/dl) was found, and spine MRI findings strongly suggested epidural abscess at the C2-L4 level. Emergency laminectomy and laminoplasty at cervical and lumbar spine, and drainage of an abscess were performed. An abscess was found in the epidural space, and a hematoma was found in the lumbar epidural space. In blood and epidural tissue cultures, Staphylococcus aureus was observed. This observation and the episode of neurological disorders after the epidural block suggested that the bolus of the epidural block was the cause of the epidural abscess. The hematoma found near the epidural injection site might have been due to the coagulation impairment caused by ticlopidine hydrochloride, and was a potential source of the bacterial infection.
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