Spinal Subdural Abscess in the Emergency Department: A Rare Diagnosis in an Immunocompetent Host.

Document Type

Article

Publication Date

9-18-2026

Publication Title

Journal of the American College of Emergency Physicians open

Abstract

Spinal subdural abscess is an exceptionally rare and potentially life-threatening spinal infection characterized by the accumulation of purulent material between the dura and arachnoid mater. In contrast to the more common spinal epidural abscess, spinal subdural abscesses have been reported in fewer than 80 cases, often in pediatric, postoperative, or immunocompromised patients. This case represents the fourth documented instance of a spinal subdural abscess in an immunocompetent adult without identifiable risk factors or a known source of infection and the first reported in emergency medicine literature. A 60-year-old immunocompetent woman presented to the emergency department with atraumatic low back pain initially attributed to lumbar radiculopathy. She returned six days later with worsening bilateral radicular pain, urinary incontinence, and systemic symptoms. Magnetic resonance imaging (MRI) revealed a large subdural fluid collection from T2 to L5, concerning for spinal subdural abscess. Emergent surgical decompression revealed frank purulence within the subdural space. Cultures grew

Volume

7

Issue

6

First Page

100499

DOI

10.1016/j.acepjo.2026.100499

ISSN

2688-1152

PubMed ID

42824197

Link to Full Text

Share

COinS