Spinal epidural abscess mimicking chloroma

Abstract

Background: Spinal epidural abscess (SEA) is a rare and generally challenging condition. It represents a challenge in terms of diagnosis and treatment due to the low incidence, vague presentation, and rapid neurologic deterioration. Case Presentation: A 40-year-old gentleman who was previously healthy was presented with a 2-week history of decreased vision associated with fever and cough one week before the eye symptoms. The patient was admitted as a case of acute promyelocytic leukemia. And was started on chemotherapy, which was complicated by septicemia and was shifted to the intensive care unit. Three weeks after admission he started to have severe non-radicular neck pain. He also had bilateral lower limb pain spasm-like in nature. Patient denies any history of trauma, weakness, numbness, saddle anesthesia or loss of sphincter control. Labs showed leukopenia, anemia and thrombocytopenia. Bone marrow result showed hypercellularity with active trilineage hematopoiesis and no immunomorphological evidence of abnormal promyelocytes or maturation arrest. He underwent C3-C4 laminectomy and evacuation of epidural pus collection. Intra-operative course was free of complication. Upon post-operative assessment he was hemodynamically stable, his neck pain was better with morphine doses and he was able to mobilize it. Conclusion: Spinal epidural abscess can mimic chloroma clinically and radiologically, however, diffusion with the images and enhancement is essential for proper assessment since a proper medical and surgical intervention is needed.