An intramedullary spinal cord abscess (ISCAs) is a rare infectious pathology with fewer than 100 cases reported in the medical literature. It can be primary (spontaneous) or secondary to infectious extension/rupture of an epidural abscess. ISCAs present with a subacute course of neurological symptoms consistent with cord compression.

MRI with contrast is the imaging modality of choice. 

Management would include: dexamethasone, surgical decompression, specimen culture, and antibiotics. Staphylococcus, streptococcus, anaerobic and microaerophilic organisms have been cultured in reported cases. 

In a patient with a history of recurrent meningitis who presents with acute transverse myelitis, a congenital dermal sinus with an intramedullary abscess should be suspected.