Spinal epidural abscess in an elderly diabetic end stage renal disease patient on continuous ambulatory peritonial dialysis (CAPD)

A 67-year-old male, a patient of diabetic nephropathy, end-stage renal disease (ESRD) on CAPD (three exchanges a day with net ultrafiltration of 1 liter) for the last 10 months, a low average transporter, presented with progressive continuous back pain in the lower thoracic region, aggravated on ambulation. There was no history of fever, motor or sensory abnormalities involving lower limbs, bladder and bowel disturbances. There was no history of trauma to spine or furunculosis or chest infection. Evaluation revealed tender indurated area over the spine in the D7–D9 (dorsal) region. There was no neurological deficit. There was polymorphonuclear leukocytosis (total WBC count 18,700/mm, neutrophils 80%) elevated ESR–139 mm/first hour, plain X-ray of thoracic spine, chest X-ray were normal. Magnetic resonance imaging (MRI) spine showed T1W (longitudinal relaxation time) iso-intense, T2 W (transverse relaxation time) hyperintense lesion noticed in an epidural location posterior to the cord at the D9–D10 level (Fig. 1). Evidence of a similar lesion was noted in The authors of the article ‘‘Spinal Epidural Abscess (SEA) in an elderly Diabetic End Stage Renal Disease patient on Continuous Ambulatory Peritoneal Dialysis (CAPD)’’ hereby transfer the copyright of the article to Kluwer Academic Publishers to ensure the widest possible dissemination of information under copyright laws.