Presentation
Three weeks history of low back pain with fever.
Patient Data
The L4 and L5 vertebral bodies, as well as the right pedicle of L5, appear of low signal on T1WI, high signal intensity on T2WI/STIR sequences with enhancement on post-contrast sequences (bone marrow edema). There is no significant narrowing of the L4-L5 disc space.
There is a fusiform multiseptate fluid collection in the anterior epidural space with heterogeneous enhancement extending from the posterosuperior angle of L4 up to S2 level with involvement of the first left sacral foraminae, in keeping with an epidural abscess. There is also extension through the L4-L5 foramina with associated abscess in the right psoas muscle.
Follow-up MRI performed two months later (under triple antibiotherapy) shows a significant improvement especially for the right psoas muscle/epidural abscesses.
Case Discussion
MRI features are characteristic of spondylodiscitis. The laboratory investigations were positive for Brucellosis. The patient was treated with triple antibiotherapy (doxycycline, rifampin, and levofloxacin). A significant improvement of the symptoms was noted as well as the follow-up MRI performed two months later.