Progressieve, opstijgende neurologische uitval: een spinaal epiduraal abces dat zich presenteert als het syndroom van Guillain-Barré

- Over the course of 4 days, a 65-year-old man developed fever and thoracic back pain, followed by weakness and sensory changes in both legs. Physical examination revealed dyspnoea, subfebrile temperature, neck pain without nuchal rigidity, sensory impairment, areflexia and weakness in both legs (and arms to a lesser extent). Guillain-Barré syndrome was considered, and treatment with intravenous immunoglobulins was started. The patient nevertheless developed respiratory insufficiency, progressive leg paresis and nuchal rigidity. Spinal MRI revealed an extensive cervicothoracic epidural abscess. Surgical decompression and drainage were performed, followed by antibiotic treatment; the patient recovered and was able to walk with assistance. A spinal epidural abscess can be difficult to recognise and is potentially lethal. The diagnosis should be considered in patients with fever and back pain, especially when these coincide with symptoms of neurological impairment. The efficacy of therapy depends on timely recognition; to this end, neuroimaging with MRI is essential.

Ned Tijdschr Geneeskd. 2008;152:1436-9