We present a case report of a man with a history of esophageal cancer who presented with fever, pain, and lower extremity weakness. The patient previously underwent chemotherapy, radiation, and immunotherapy treatment. He also underwent esophageal dilation, stent placement, and removal. MRI scans of the spine revealed a longitudinal spinal epidural abscess (SEA) resulting in compressive myelopathy. The suspected infection cause was gastrointestinal-associated Gram-negative rods tracking to the epidural space from an esophageal fistula. This case demonstrates the importance of early diagnosis and treatment and the role of fistula as an infection source in SEA.