Nonsurgical Management of Pan‐Spinal Epidural Abscess Caused by <i>Streptococcus mitis</i> : A Case Report

Introduction Spinal epidural abscess (SEA) is a rare but potentially devastating infection. Pan‐spinal SEA (Pan‐SEA), involving the entire spinal axis, is even rarer and typically managed with surgical drainage and antibiotics. Streptococcus mitis is an uncommon causative pathogen. We report a rare case of Pan‐SEA successfully treated with antibiotic therapy alone. Case Presentation A 52‐year‐old woman presented with progressive back pain and fever following an epidural block performed 22 days earlier. Laboratory tests showed a marked inflammatory response (white blood cell count 36,300/μL; C‐reactive protein 27.5 mg/dL). Noncontrast and contrast‐enhanced computed tomography revealed suspected bone destruction at the Th11/12 facet joint and fluid collection within the spinal canal. Contrast‐enhanced magnetic resonance imaging demonstrated a continuous anterior epidural abscess extending from C1 to L2/3, consistent with Pan‐SEA. Blood cultures grew Streptococcus mitis , and follow‐up cultures confirmed clearance of bacteremia. Despite risk factors for medical treatment failure, the absence of neurological deficits, ventral abscess location, and clinical stability supported conservative management. Antimicrobial therapy was administered for 8 weeks, including ampicillin–sulbactam followed by ampicillin. Serial MRI on hospital days 16 and 37 demonstrated progressive resolution of the abscess. The patient recovered fully without neurological sequelae. Conclusion This case demonstrates that antibiotic‐only management may be a feasible option for carefully selected patients with Pan‐SEA caused by low‐virulence pathogens such as Streptococcus mitis. Serial contrast‐enhanced MRI is essential for guiding treatment decisions and confirming therapeutic response.