Our patient did not have a history of chronic or recurrent meningitis, and it is likely that this was a first manifestation of both meningitis and intramedullary abscess for this patient. However, as described above, most patients who develop an intramedullary abscess have some predisposition to the condition. In the case of our patient, it is likely that his sickle cell condition, which can cause vasoocclusive disease and/or an immunocompromised state, drove the pathogenesis toward intramedullary abscess formation. Unfortunately, the status of the sickle cell disease in our patient was unknown, given the clinical circumstances and urgency surrounding his case. The patient would be likely to have a functional asplenia, starting early in childhood, which may predispose one to serious infections. Additionally, echocardiography was not performed to rule out pneumococcal endocarditis, which may occur in a triad of symptoms called Austrian syndrome . However, the use of broad-spectrum antibiotics may have reduced the risk of pneumococcal endocarditis, as discussed in other reports . While intramedullary abscess formation is a rare entity, we propose that a high index of suspicion for intramedullary abscess is the key to the diagnosis and expedited treatment for these patients.