We present a case report of a patient who developed cauda equina syndrome from infectious arachnoiditis following prostate biopsy. We would like to underscore the direct continuity of the prostatic venous plexus with the vertebral venous plexus as the etiology and mechanism of arachnoiditis in our patient.

Spinal arachnoiditis is an inflammatory disease of the arachnoid membrane of the spinal cord that can by caused by trauma, spinal cord tumors, spinal cord contamination, or infections. The prostate venous plexus can flow into the vertebral venous plexus providing a pathway to spread infections from the prostate to the vertebral column. Clinical symptoms can range from radicular pain in the lower extremities, bowel and urinary incontinence, as well as motor and sensory deficits.

63-year-old male with history of diabetes mellitus type 2, coronary artery disease, ischemic cardiomyopathy with mildly reduced ejection fraction of 45-50%, stage III chronic kidney disease, hypertension, hyperlipidemia, newly diagnosed prostate cancer s/p biopsy one month prior, presented to the hospital with low back pain, bilateral leg weakness and pain, bowel and bladder incontinence ongoing for 10 days. He was found to have acute COVID-19 infection, ESBL E. Coli UTI, bacteremia with ESBL E.coli. Neurological exam revealed paraparesis right lower extremity 3/5, left lower extremity with 2/5, hyperreflexia in bilateral DTRs, upgoing toes bilateral as well as decreased sensation in bilateral lower extremities. MRI complete spine survey demonstrated epidural gas in lumbar spine extending from L1 to L4, osteomyelitis with discitis at the L3-4 and L4-5 segments, and arachnoiditis. CSF gram stain grew ESBL E.coli. Patient was treated with meropenem.

We highlight a case report of a patient who underwent prostate biopsy and one month later was found to have Cauda equina syndrome with ESBL E.coli infectious arachnoiditis.