A case of bacterial intramedullary spinal cord abscess and cauda equina neuritis that resolved with conservative treatment

The patient is a woman in her 70s. Low back pain and left lower limb pain gradually worsened since 1 month ago, urinary retention and bilateral lower limb paralysis appeared and she was admitted to our department. Muscle weakness in both lower limbs, hypoesthesia and pain in both lower limbs predominantly in the right side, and loss of tendon reflexes in both lower limbs were observed. MRI showed severe lumbar deformity as well as swelling of the spinal conus medullaris, ring-shaped contrast effect, and contrast effect of the cauda equina nerve. Diffusion-weighted images of the spinal conus showed multifocal high signal. Cerebrospinal fluid showed 271 cells/mm³ (72% polymorphonuclear cells), 356 ‍mg/dl protein, 15 ‍mg/dl sugar, and negative bacterial culture. Suspecting bacterial intramedullary spinal abscess and cauda equina neuritis, she was started on intravenous Ceftriaxone (CTRX)/ Vancomycin (VCM) and oral MNZ. Thereafter, muscle weakness and sensory disturbance in both lower limbs gradually improved, and the patient was able to walk with a cane one month later. Cerebrospinal fluid and MRI findings gradually normalized. The diagnosis of bacterial intramedullary spinal cord abscess and cauda equina neuritis was made, which improved with conservative treatment.