The Enigmatic Presentation of Pneumorrhachis in Necrotizing Soft Tissue Infection: A Case Report

Pneumorrhachis, the presence of air within the spinal canal, is an uncommon radiologic finding, most often resulting from trauma or iatrogenic procedures, or exceedingly rarely, infectious causes. We present a case of necrotizing soft tissue infection overlying the sacrum, not associated with a preexisting pressure ulcer/wound, leading to pneumorrhachis, pan myelomeningitis, and epidural abscess formation. Initial diagnosis was assumed to be a buttock abscess, but additional symptoms of severe weakness and lethargy elicited further studies. Prompt diagnosis was achieved with computed tomography, magnetic resonance imaging, and operative intervention, leading to a more favorable outcome. This case exemplifies the need to maintain high awareness for seemingly mundane symptoms, as they may mask more serious pathologies like pneumorrhachis or epidural abscess.