Spinal epidural abscess caused by Acinetobacter baumannii mimicking a herniated lumbar disc

Background: A vertebral epidural abscess usually offers a very varied clinical picture of systemic involvement with signs of infection, general malaise and neurological focus. It is diagnosed by means of magnetic resonance imaging, which reveals large lesions with frequent involvement of soft tissues and peripheral contrast enhancement.

Methods: A 35-year-old male with lumbar-radicular pain in the right S1 with Lasègue's sign at 20 degrees on the right side and abolition of the Achilles' reflex. Magnetic resonance imaging showed an extradural lesion in L5-S1, dependent on the disc space, which suggested a herniated disc. The rest of the anamnesis, explorations and analyses were normal except for a slightly high erythrocyte sedimentation rate. The patient was submitted to surgery and an epidural abscess was observed from which an Acinetobacter baumanii was recovered. Treatment was established with antibiotics and a rigid lumbosacral orthosis. At three months clear signs of discitis were observed in magnetic resonance images; these were completely resolved at eight months, when the patient was asymptomatic.

Conclusions: Epidural abscess must be included in the differential diagnosis of a herniated disc because in the early phases it can give rise to symptoms of lumbar-radicular pain that are identical to those caused by a herniated lumbar disc. This is the first case of an epidural abscess produced by A. baumanii.