Abstract

Epidural abscesses, rare and potentially life-threatening infections located between the dura mater and vertebral wall, can cause severe neurological deficits due to spinal cord compression or vascular compromise. This condition is classified into spinal epidural abscess (SEA) and intracranial epidural abscess (IEA). Despite its rarity, SEA carries a high mortality rate (4.6%–31%). We report a case of a 70-year-old diabetic, hypertensive male with a history of ischemic heart disease who presented with fever, altered mental state, and meningeal signs. Initially diagnosed and treated as meningitis, the patient’s condition persisted despite antibiotic therapy. Further investigation revealed a cervical SEA, with an abscess causing spinal cord compression, confirmed by MRI. The infection was found to be caused by methicillin-sensitive Staphylococcus aureus (MSSA), and the patient underwent successful surgical debridement and drainage. Post-surgical recovery was marked by significant improvement. This case underscores the importance of considering dual brain and spine involvement in patients with neurological symptoms, even in the absence of classic risk factors. Early spinal imaging is crucial in diagnosing SEA and preventing irreversible neurological damage. Physicians should maintain a high index of suspicion for spinal epidural abscess in patients with persistent fever and neurological symptoms, regardless of initial diagnosis.