Endocrinology, Diabetes & Metabolism Case Reports (Feb 2021)

Fatal epidural abscess from diabetic foot disease

  • Aditi Sharma,
  • Thilipan Thaventhiran,
  • Suzanne Braggins,
  • Channa N Jayasena,
  • Vassiliki Bravis

DOI
https://doi.org/10.1530/EDM-20-0129
Journal volume & issue
Vol. 1, no. 1
pp. 1 – 5

Abstract

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Infection is a common complication of advanced diabetic foot disease, increasing the risk of acute admission and amputation. It is less well-known that foot ulceration and osteomyelitis may cause bacteraemia-associated hematogenous seeding and subsequent epidural abscess formation. Here we describe the case of a 57-year-old woman with known diabetic foot ulcer with underlying osteomyelitis admitted with backpain in the absence of trauma. Her condition deteriorated secondary to overwhelming sepsis. MRI of the spine confirmed spondylodiscitis and posterior epidural collection, not amenable to surgical intervention due to patient’s comorbidities and high surgical risk. Despite prolonged antibiotic therapy, the patient died following a hospital admission lasting 2.5 months. This case highlights the importance of regular contact with diabetes foot service for optimisation and prompt treatment of diabetic foot disease, which can be an underestimated potential source of remote site invasive systemic infection. Secondly, high clinical suspicion in admitting clinicians is imperative in ensuring timely diagnosis and early intervention to minimise fatal consequences.