Which combination constitutes red flags for an epidural abscess requiring prompt evaluation?

• A. Isolated back pain with no neurological signs
• B. Fever without back pain
• C. Fever with back pain and neurologic signs
• D. Chronic headaches

Answer: (C)

The key idea is that fever with back pain plus new neurologic signs signals a possible epidural abscess that can rapidly worsen and cause irreversible nerve damage if not evaluated quickly. Fever shows infection, back pain points to the spine, and neurologic signs indicate that the infection may be affecting neural tissue or causing compression. Because of the risk of rapid progression, this combination requires urgent MRI of the spine with contrast and prompt specialist management (antibiotics and possible decompression). The other scenarios lack this combination: back pain without neurologic signs is less alarming for an abscess; fever without back pain doesn’t localize to the spine; chronic headaches aren’t related to an epidural abscess.