Two Cases of Spontaneous Epidural Abscess in Patients With Cirrhosis

Raymond K. Cross Jr., MD, Charles Howell, MD


South Med J. 2003;96(3) 

In This Article

Abstract and Introduction

Medical conditions predisposing to epidural abscess include diabetes, intravenous drug use, alcoholism, and other immunocompromised states. Although cirrhosis is associated with an increased risk of infection in general it has not previously been identified as a condition predisposing to epidural abscess. We describe two cirrhotic patients with spinal epidural abscesses. We speculate that the underlying immune defects associated with cirrhosis increase the risk of spontaneous epidural abscess and should raise concern for this infection when cirrhotic patients present with fever and back pain.

Spinal epidural abscess is an uncommon condition, with an incidence between 0.2 and 2.8 per 10,000 hospital admissions. Infection of the epidural space may develop by direct extension of infection from an adjacent vertebra or intervertebral disc, from overlying skin, pharynx, and kidney or by hematogenous spread from remote infections. Patients undergoing invasive spinal procedures and patients who suffer blunt trauma to the spine are also at risk for epidural abscess. Medical conditions predisposing to epidural abscesses include diabetes mellitus, intravenous drug abuse, chronic renal failure, alcoholism, and cancer.[1,2,3] To our knowledge, chronic liver disease has not previously been identified as a condition predisposing to epidural abscesses. We describe two cases of spontaneous epidural abscess in women with underlying cirrhosis.