A fatal ascending spinal subdural empyema due to Streptococcus intermedius in a socially vulnerable patient: Forensic perspectives on diagnostic delay and implicit bias.
Loredana Buscemi, Edoardo Barboni, Marco Palpacelli et al.
✦ AI-curated · Sources linked
Case in brief
A 63-year-old man with a history of repeated emergency department visits presented with persistent lower back pain and neurological symptoms. Despite these red flags, advanced neuroimaging and further evaluations were delayed, resulting in a fatal ascending spinal and cranial subdural empyema caused by Streptococcus intermedius. The patient ultimately succumbed to septic shock and multi-organ failure.
What made this case unusual
The case underscores the impact of implicit bias and organizational factors on diagnostic delays in a socially vulnerable patient, leading to a life-threatening condition.
Diagnostic / clinical pearl
Clinicians should remain vigilant for red flags in patients with repeated ED visits, particularly in socially vulnerable populations, to avoid diagnostic delays.
Why it matters
This case emphasizes the need for awareness of implicit bias in clinical settings and the importance of systematic interventions to improve diagnostic accuracy and equity in emergency care.