Presentation
Back pain with palpable mass.
Patient Data
L2-L3 osteomyelitis/diskitis. Slight kyphotic deformity.
Thin fluid tracking along anterior longitudinal ligament, with slight irregularity of anterior L4, larger amount of presacral fluid.
Destructive changes in S2-S3.
Multifocal abscesses: Psoas muscles (left contains calcifications), left paraspinal muscles extending into subcutaneous fat, left gluteus muscle.
Case Discussion
Tuberculous spondylitis with subligamentous spread involving the lumbar spine and sacrum, and large paraspinal abscesses.
The indolent presentation can result in delayed diagnosis and greater morbidity. This young patient presented with relatively vague symptoms mostly focussed on his palpable mass in his lower back, but already has developed a good deal of bone loss in L3 and mild focal kyphosis (gibbus deformity).
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