Involvement of two adjacent vertebrae and their end plates with or without intervening disc signal changes should raise the suspicion of spondylodiscitis. Extension of inflammation into pre and paravertebral spaces results in spread to psoas muscles. In this case, it resulted in a large abscess. Tuberculosis should always be included in the differential whenever the imaging findings are disproportionately more in comparison to the clinical picture. 

Case courtesy Dr Aarathy Appukuttan.