Epidural abscesses are common among patients with a history of intravenous drug use, but rarely do they present with intramedullary cord abscess. In one case, a patient developed tetraplegia and was found to have an intramedullary abscess caused by Pseudomonas cepacia . In another case, an intravenous drug user presented with a similar clinical presentation, but the abscess was infected with Staphylococcus aureus . In a couple of other reports, one patient developed an intramedullary abscess, likely from his right to left cardiac shunt, through bypassing the normal host defenses in the lungs , and two separate patients had a patent foramen ovale [7, 8].