A case of spinal epidural abscess in a renal transplant recipient

: A 44-year-old male underwent a cadaveric renal transplantation at the university hospital of Tsukuba on March 3, 1979. On June 11, 1979, he was discharged this hospital. Immunosuppressive therapy with azathioprine and methylprednisolone was done. On November 1, 1979, he developed back pain associated with fever. On November 3, 1979, he was admitted to the university hospital of Tsukuba. Laboratory study revealed leucocytosis. CRP inserum was positive. But pneumonia, urinary tract infection and infectious skin lesion were ruled out by physical, radiological and laboratory examination. On November 16, 1979, he became paraparetic. On the next day, he consulted the neurosurgical unit. Neurological findings were as follows: paraplegia, and hypesthesia and hypalgesia below the level of T4, and bilateral hyperrefrexia of P.T.R. and A.T.R. Lumbar myelogram revealed a complete block at the level T7. On November 17, 1979, a laminectomy from T4 through T7 was performed. The epidural abscess containing yellow pus was found and totally removed. Gram-positive rods were isolated on bacteriologic culture. On the 7th postoperative day, the sensory level dropped to L4 bilaterally and the muscle strength in the lower extremity became fair. About 3 years after operation, he became to be able to walk without cane. Discussion was made about this case together with previously reported cases.