Acute epidural abscess complicating pneumococcal meningitis in adult.

Acute spinal epidural abscesses rarely complicate bacterial meningitis in adults. We report an uncommon case of advanced pneumococcal meningitis complicated by acute lumbar epidural abscess in an adult. A 35-year-old man was admitted to the medical intensive care unit with pneumococcal meningitis. On the eighth day of hospitalization, he presented a cauda equine syndrome with flaccid paraplegia, saddle anesthesia, and bladder and bowel dysfunction. Magnetic resonance imaging (MRI) of the spine demonstrated a suppurative collection at L2-L3. Surgical decompression was performed, and antibiotherapy was followed for eight weeks. Clinical improvement was progressive over eight months. New onset neurologic deficits in a patient with pneumococcal meningitis should raise suspicion of acute epidural abscess.