Endocrine Abstracts

A 59-year-old gentleman presented with a 6-month history of painless, progressive lower limb weakness. There was no history of trauma or weight loss although he had been suffering night sweats. He had been bed bound for 4 weeks prior to admission. He was an insulin-dependent type 2 diabetic.

Examination revealed marked symmetrical wasting of the leg muscles with reduced power (3/5) and absent reflexes and plantar reflexes were up-going. He was in urinary retention. He had established peripheral neuropathy complicated by diabetic foot ulceration managed under the care of the GP and practice nurses for the previous 8 months. The ulcers appeared infected; a wound swab grew methicillin-sensitive staphylococcus aureus. Inflammatory markers (white cell count (WCC) and C-reactive protein (CRP)) were high. CT head revealed no cause for the limb weakness. He was catheterised, started on oral antibiotics for his foot wounds and transferred to the diabetic ward.

He had an MRI whole spine performed which showed a paraspinal abscess at the level of C6–T1 and epidural collection from T6 to T9 with associated spinal cord abscess. He was started on high dose i.v. flucloxacillin and discussed urgently with the Neurosurgical team who recommended continuing antibiotics and interval MRI scanning. His foot ulcers were managed by the High Risk Diabetic Foot Team. Six weeks later he was ambulant with a walking stick, his CRP and WCC were improving and scans revealed some resolution of the spinal collections. He was discharged home on oral flucloxacillin with follow-up under the Neurosurgeons and ongoing podiatric care.

Epidural and spinal cord abscess is a rare complication of infected diabetic foot ulcers. S. aureus is the most common organism. Prompt assessment (<24 h) of new diabetic foot wounds by expert practitioners now forms part of the recommended framework of care from NICE.