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Background and Aims Epidural empyema is a rare complication following epidural catheter (EPC) placement. It’s a life-threatening situation if not quickly diagnosed and treated with risk of permanent neurological damage.

Methods An EPC was placed on a 62YO ASAIV male with acute peripheral obstructive artery disease undergoing lower limb angioplasty.

Results Nineteen days later he presents with fever and increased inflammatory parameters. Neurological examination was unremarkable. EPC insertion site didn’t show inflammation or infection signs of. Pseudomonas Aeruginosa was isolated in urine and blood cultures and empirical antibiotic therapy was started. On 20th day, purulent exudate at the EPC insertion site appeared and the EPC was removed. The patient remained without neurologic deficits or meningeal signs. P.aeroginosa was isolated from EPC tip culture and antibiotic therapy was targeted. Two days after, loss of sensitivity at L1-L4 territories and loss of anal sphincter continence appeared. No motor deficits. An urgent MRI revealed an empyema from S3-T9 without significant spinal cord compression or distress signs. Neurosurgery recommended Conservative management was recommended by neurosurgery. One week after targeted antibiotic therapy, deficits reversed to patient‘s baseline. Three months follow-up revealed no sensory or motor sequelae.

Conclusions This case represents a CNS infection after EPC technique resulting from a neuraxial anesthetic technique with a favorable evolution under conservative treatment. The diagnosis requires a high degree of suspicion and is not excluded by absence of neurological deficits. Inflammatory markers are a warning sign but only MRI could confirm the diagnosis. Timely diagnosis and multidisciplinary approach are essential and mandatory.