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Background Longitudinally extensive spinal cord lesions are most commonly due to inflammatory or vascular etiologies - such as a spinal cord infarct. Dural arteriovenous fistulas (dAVFs) are recognised as a rare cause of a longitudinally extensive spinal lesion. Infectious myelitis is rare. The association of a dAVF with infectious myelitis is exceedingly rare.Case Presentation A 78-year-old male with no significant medical history presented with a progressive lower limb paraparesis over 24 hours accompanied by a fever. Initial imaging revealed a longitudinally extensive cord signal change from the C5 to the conus medullaris. Lumbar puncture revealed a highly cellular PMN predominant CSF with elevated lactate, suggesting bacterial infectious myelitis.Subsequent imaging including digital subtraction angiography identified a dural arteriovenous fistula (dAVF) and extensive cord infarction. We hypothesised that the dAVF developed secondary to the inflammatory and infectious process. Due to the risks associated with surgical intervention and the extensive cord damage on MRI the patient was treated conservatively with steroids and antibiotics. Unfortunately, there has been no improvement in his lower limb function, and he remains densely paraplegic.Discussion This case highlights a case of dAVF developing as a secondary complication of bacterial LETM and the associated morbidity.kiran.pillai@nhs.net