Spinal epidural abscess differential diagnosis [Neurosurgery Wiki]

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====== Spinal epidural abscess differential diagnosis ======

[[Spinal epidural abscess]] should be considered in any patient with backache, fever, and spine tenderness,
((Heusner AP. Nontuberculous Spinal Epidural Infections.
N Engl J Med. 1948; 239:845–854))
especially diabetics, IV drug abusers or immunocompromised patients. 

1. meningitis

2. acute transverse myelitis (paralysis is usually more rapid, radiographic studies are normal)

3. intervertebral disc herniation

4. spinal cord tumors. Consider malignancy in the differential diagnosis, and carefully examine surgical specimens in revision surgery
((Wang SJ, Cao DL, Xu HW, Zhao WD, Hu T, Wu DS. Development of Primary Diffuse
Large B-cell Lymphoma around an Internal Fixation Implant after Lumbar Fusion
Surgery: A Case Report and Review of the Literature. World Neurosurg. 2020 Feb 5.
pii: S1878-8750(20)30245-X. doi: 10.1016/j.wneu.2020.01.227. [Epub ahead of
print] PubMed PMID: 32035201.
)).

5. post-op SEA may appear similar to pseudomeningocele
((Spiegelmann R, Findler G, Faibel M, et al. Postoperative
Spinal Epidural Empyema: Clinical and
Computed Tomography Features. Spin e. 1991;
16:1146–1149)).
----
Langerhans cell histiocytosis (LCH) could be considered as a possible diagnosis when a patient presents with features of infectious spondylitis with vertebral involvement
((Lim CS, Cho JH. Spinal epidural involvement in adult Langerhans cell
histiocytosis (LCH): A case report. Medicine (Baltimore). 2020 Jan;99(3):e18794. 
doi: 10.1097/MD.0000000000018794. PubMed PMID: 32011480.
)).
----
A case of a 21-year-old woman presenting with quadriplegia which was initially diagnosed with an epidural abscess in view of her MR scan and raised inflammatory marker levels. Histology revealed an epidural extra-osseous Ewing's sarcoma (EES). Epidural location of EES is a very rare condition which can be very challenging to diagnose. Early diagnosis and surgical excision followed by chemotherapy represent the main stem of management
((Bailey M, Mccabe M, Pal P, Agushi E, Karabatsou K. Cervical epidural
extra-osseous Ewing sarcoma mimicking an epidural abscess. Br J Neurosurg. 2016
Feb;30(1):113-4. doi: 10.3109/02688697.2015.1071337. Epub 2015 Sep 7. PubMed
PMID: 26982951.
)).