April 5th, 2020

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Surgical Management of Spinal Epidural Abscess in a Term Pregnancy: Delivery Versus Decompression: A Case Report
Authors:  Jane Martin, M.D., Juanita Garces, M.D., Cuong J. Bui, M.D., and Sherri Longo, M.D.
BACKGROUND: Acute neurologic deficits in pregnancy may be caused by a variety of etiologies. Spinal epidural abscesses are rare in the pregnant and nonpregnant state and are frequently missed on initial evaluation due to their nonspecific signs and symptoms. Only 5 cases of epidural abscesses in pregnancy have been documented in the literature, and none in a term pregnancy.

CASE: A 31-year-old woman, gravida 4 para 3, presented with acute paraplegia at 37 weeks’ gestation. She was diagnosed with thoracic spinal epidural abscess and was in labor. She underwent emergent repeat cesarean delivery followed immediately by decompressive laminectomy.

CONCLUSION: Spinal epidural abscess should be considered in a gravid patient with acute neurologic complaints including back pain, paraplegia, and paresthesia and signs of systemic infection. The long-term sequelae from delayed diagnosis can cause devastating maternal and fetal outcomes.
Keywords:  cesarean section, repeat; epidural abscess; epidural abscess, spinal; intravenous drug abuse; laminectomy; paraplegia; pregnancy complications
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