Spinal epidural abscess is rare in childhood. In this case, findings from the initial MRI and computed tomographic scan were confusing as the pus decompressed into the paraspinal muscles, resulting in a secondary pyomyositis. Rubin et al1 reviewed spinal epidural abscess in 1993, and they note that childhood spinal epidural abscess is usually of hematogenous origin, and S aureus is the usual etiologic agent (79% of all cases). It is seen more often in patients younger than 2 years or older than 12 years. The symptoms differ according to age. In a child younger than 2 years, neurological compromise at presentation is common. Older children often are seen for back pain and fever, although abdominal and hip pain are also presenting signs. The outcome correlates with the presence or absence of neurological signs at presentation. The definitive treatment is surgical drainage and antibiotic administration.