CLINICAL REPORT Spinal Epidural Abscess as a Result of Dissemination from Gluteal Abscess Secondary to Intramuscular Analgesic Injection Mehdi Sasani, MD*; Ozlem Aydin, MD † ; Ahmet Levent Aydin, MD ‡ ; Tunc Oktenoglu, MD*; Ali Fahir Ozer, MD*; Omur Ercelen, MD § *Neurosurgery Department, American Hospital, Istanbul; † Infectious Disease and Clinical Microbiology Department, Haseki Training Hospital, Istanbul; ‡ Neurosurgery Department, Istanbul Physical Therapy and Rehabilitation Hospital, Istanbul; § Anesthesiology and Reanimation Department, American Hospital, Istanbul, Turkey  Abstract: Spinal epidural abscess is a collection of suppu- rative material that forms between the dura mater and the ligamentum flavum. If not recognized early and treated cor- rectly, it can lead to life-threatening sepsis. Here we report the case of a female patient, 51 years of age, with difficulty walking and bilateral leg pain after having had degenerative discogenic pain for many years. The patient had occasionally received intramuscular non-steroidal anti-inflammatory drug injections. The current report is that of an unusual case of epidural abscess that formed following multiple dose of intra- muscular non-steroidal anti-inflammatory drug over a 1-year period. Hematogenous or direct dissemination is the sus- pected cause. To prevent serious morbidity and mortality, early diagnosis is essential. Patients with localized back pain who are at risk for developing such epidural spinal abscesses should receive a magnetic resonance imaging scan with contrast enhancement without delay. The existence of predis- posing factors such as intramuscular injections should be considered in the assessment of suspected spinal epidural abscess.  Key Words: epidural abscess, gluteal abscess, degenerative discogenic pain, injection, complication, infection INTRODUCTION Spinal epidural abscess (SEA) is a pus collection between the dura mater and ligamentum flavum. Spontaneous epidural abscess is a relatively rare disease, accounting for 0.2–1.2 cases per 10,000 hospital admissions per year 1 but presents a clinical picture with which all phy- sicians must be familiar. If not recognized and treated early, an expanding suppurative infection in the spinal epidural space impinges on the spinal cord. 2,3 Paralysis in the distribution of caudal segments of the spinal cord in patients with acute infection of the epidural space is rarely reversible. It may also lead to life-threatening sepsis. 4 Early diagnosis of SEA can prevent catastrophe when clinicians maintain a high degree of awareness. SEA usually occurs secondary to hematogenous dis- semination; it may also result from a local extension of infection from adjacent structures, as a complication of Address correspondence and reprint requests to: Mehdi Sasani, MD, American Hospital-Neurosurgery Department, Guzelbahce Sk. No:20/ 34365 Nisantasi, Istanbul, Turkey. E-mail: sasanim@gmail.com. Submitted: February 23, 2009; Revision accepted: May 29, 2009 DOI. 10.1111/j.1533-2500.2009.00304.x © 2009 World Institute of Pain, 1530-7085/09/$15.00 Pain Practice, Volume 9, Issue 5, 2009 399–403