An elderly female w/ history of laminectomy and recent spinal anesthesia presents with acute onset fever and midline low back pain, ultimately found to have subtle enhancement on MRI consistent with an early epidural abscess.
*Because of advanced imaging, we are often catching epidural abscesses at an earlier stage than before. If the clinical scenario fits, even these small enhancements should be treated with IV abx to prevent progression to larger epidural abscesses
*Reimaging for epidural abscess is not recommended unless there is concern for treatment failure (uptrending inflammatory markers, new neuro sx, worsening pain/fever)
Kaiser SF Internal Medicine Residency Blog 