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Neurological Rehabilitation

Incomplete Spinal Cord Injury From Spinal Epidural Abscess After Influenza Vaccination: A Case Report

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 5
Has Audio
Disclosure(s):
Sudeep Peddireddy, MD: No financial relationships to disclose
Priya Patel, DO: No financial relationships to disclose
Noah T. VanWingerden, MD: No financial relationships to disclose
Case Diagnosis: T8 AIS C Spinal Cord Injury Secondary to Spinal Epidural Abscess After Influenza Vaccination

Case Description or Program Description: A 67-year-old male with hypertension, hyperlipidemia, Factor V Leiden, and a remote history of previous bilateral knee and hip arthroplasties presented to the emergency room with mid-to-low back pain one week after receiving an influenza vaccine. Otherwise, he was relatively healthy with no recent infections. His initial evaluation, including computed tomography imaging of the thoracic spine, revealed no acute abnormalities and he was discharged home. After returning home, he developed low-grade fevers, progressive bilateral lower extremity weakness, sensory deficits, urinary retention, and constipation, requiring immediate return to the hospital two days later. Magnetic resonance imaging of his thoracic spine revealed osteomyelitis/discitis and a paravertebral abscess at T7-T8, an epidural abscess spanning T7-T10 levels, and an epidural phlegmon at T8-T9, with associated spinal cord compression. The patient underwent an emergent T7-T9 decompressive laminectomy with abscess evacuation. Intraoperative blood cultures grew Streptococcus intermedius, necessitating an eight-week course of intravenous ceftriaxone. Transthoracic and transesophageal echocardiograms showed no evidence of infective endocarditis and cultures grown from incidental pleural effusions were also negative.

Setting: Acute inpatient rehabilitation facility

Assessment/Results: The patient’s spinal cord injury was initially graded as a T8 AIS C on the ASIA Impairment Scale. On admission, he required minimal assistance for bed mobility, upper body dressing, and grooming; maximal assistance for transfers and toileting; and total assistance for lower body dressing. After completing a seven-week inpatient rehabilitation program, he was performing all of these activities at a supervision to modified independence level.

Discussion (relevance): Based on our literature search, this is the first reported case of a spinal epidural abscess following influenza vaccination that led to an incomplete spinal cord injury.

Conclusions: A rare but potentially devastating reaction to the influenza vaccination may include the development of a spinal epidural abscess.