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A Case of Autonomically Mediated Pain Due to Spinal Epidural Abscess in an Adolescent Female

Rook, James L. DO, MPH*; Duffey, David DO; DeRoos, Steven MD

doi: 10.1097/PEC.0b013e31821d86d5
Illustrative Cases

Spinal epidural abscess (SEA) is a rare disease in children without predisposing risk factors. Atypical presentations of SEA without the classic triad of fever, back pain, and neurological signs, have previously been described. We report an atypical presentation of an acute SEA in a previously healthy adolescent female. This 15-year-old patient presented with right shoulder pain in the absence of the fever, back pain, or long-tract signs; therefore, the diagnosis of the spinal pathology was delayed. Eventually, a thoracic SEA was identified by gadolinium-enhanced magnetic resonance imaging and treated with surgical decompression followed by intravenously administered antibiotics. The patient's course was complicated by chronic headache. Our experience adds to the literature a case that demonstrates the difficulty in diagnosis of atypical presentations of SEA in previously healthy children. In addition, referred or autonomically mediated pain should be considered in unusual pain presentations. Children with significant extremity or abdominal pain should be considered for the possibility of sympathetically mediated pain syndrome due to a thoracic-level spinal cord lesion such as a SEA.

From the *Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA; and Departments of †Pediatrics and ‡Pediatric Neurology, Helen DeVos Children's Hospital, Grand Rapids, MI.

Reprints: James L. Rook, DO, MPH, Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson St, Room 2536 Loma Linda CA 92354 (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.