Fungal Spinal Epidural Abscess: A Mystifying Quagmire.

Aim and background: Spinal epidural abscess (SEA) is the collection of pus mostly affecting the epidural space of the spine. Tubercular and fungal etiologies are more commonly accountable for SEA in developing countries and in immunocompromised populations. Case description: The patient presented to us with complaints of fever, bilateral lower limb weakness, and urinary retention of 2 weeks' duration. After contrast-enhanced magnetic resonance imaging (CEMRI) revealed a posterior epidural collection in the dorsal spine, he was empirically started on antibiotics, antitubercular drugs, and steroids. Following an urgent neurosurgical consultation, he underwent a two-level dorsal (D6-D7) laminectomy with evacuation. The drained pus sample revealed Candida albicans growth, which was sensitive to fluconazole. He was started on intravenous (IV) fluconazole followed by echinocandins. Amphotericin, which remains the drug of choice for invasive Candida of the nervous system, could not be initiated in our patient despite the identification of the species, in view of rapidly progressive renal failure. Unfortunately, despite all measures, his condition continued to deteriorate, and he finally succumbed to acute renal failure and sepsis. Conclusion: Spinal epidural abscess is a rare but potentially fatal disease that is often missed or misdiagnosed. Appropriate and timely treatment can help reduce the rate of mortality and morbidity from this fulminant disease. Clinical significance: Fungal SEA is a rare entity and often goes undiagnosed, leading to its mismanagement and subsequent high morbidity and mortality. [ABSTRACT FROM AUTHOR]