Background Diabetes mellitus (DM) is a chronic metabolic disorder with considerable morbidity and mortality in multiple organs, essentially the cardiovascular, renal, and ophthalmological complications in addition to complications in multiple connective tissues, such as the bones, cartilage, and nerves.

The spine includes a variety of connective tissues that may be adversely affected by diabetes. Moreover, DM is a known risk factor for certain infections because diabetic individuals with uncontrolled diabetes are immune compromised due to negative effects of hyperglycemia that favors immune dysfunction in various mechanistic pathways. Therefore, DM requires continuous medical care and patient self-education to achieve optimal glycemic control, which is the cornerstone in reducing the risk of those long-term complications.

Case Report(s) We are presenting an 11-years old male child living with Type 1 DM for 3 years associated with poorly controlled glycemic state, who presented to us with acute onset of back pain followed by weakness of both lower limbs in addition to urinary and stool incontinence. MRI dorso- lumbar spine with IV contrast revealed a well-defined intra-spinal, intra-dural and extra- medullary space occupying lesion opposite D5 and D6 levels inflammatory in nature. Our patient showed dramatic spontaneous improvement with full recovery of the neurological functions within a few days on antibiotics, dexamethasone together with strict glycemic control

Conclusion(s) Pediatric spine infections are extremely rare entities with no clear guidelines for management that requires a multidisciplinary approach. Early diagnosis is crucial as it allows the initiation of the appropriate antimicrobial therapy, and it may decrease the need for subsequent complex surgical interventions. Uncontrolled DM is an additional burden in the management of such a serious condition.