A Case of Cervical and Thoracic Epidural Abscess Presenting As Diabetic Ketoacidosis Amid Persistent Bacteremia and Alcohol Withdrawal

This is a case of a spinal epidural abscess (SEA) in a 41-year-old male with a history of chronic alcohol abuse, who initially presented with severe diabetic ketoacidosis (DKA). Following stabilization of DKA, the patient developed persistent gram-positive bacteremia, which progressed to an epidural abscess extending from the cervical to the thoracic spine with potential intracranial extension. Despite the complexity of the case, prompt diagnosis via magnetic resonance imaging (MRI) and timely neurosurgical intervention for drainage, combined with targeted antibiotic therapy, led to a favorable outcome. SEA remains a rare but serious complication, particularly in the context of DKA and bacteremia. Early recognition and intervention are crucial to prevent neurological sequelae. This case emphasizes the importance of maintaining a high index of suspicion for SEA in patients with risk factors such as diabetes and alcohol abuse, particularly when they present with new or worsening back pain and systemic signs of infection.