Lumbosacral and pulmonary tuberculosis

Case contributed by Dr Hamdy Mohammed Ibrahim

Presentation

Presented with spasm of the left lower limb with an inability to extend it with ease. Ultrasound revealed a left psoas muscle collection. A pigtail catheter was inserted and fluid obtained.

Patient Data

Age: 35 years
Gender: Male

Bilateral scattered pulmonary cavitary lesions largest seen at the right lung apex. The mediastinum demonstrates enlarged matted lymph nodes with faint homogeneous enhancement. Some show foci of calcification.

Abnormal erosion and sclerosis of L5 and S1 opposing vertebral body endplates with increased intervening disc density as well as extension of the abnormal disc material to the epidural and paravertebral spaces, the latter seen over the psoas muscle on both sides. Left sided pigtail catheter. 

Splenic and anteroinferior left kidney hypoenhancement. 

Case Discussion

CT chest abdomen pelvis was performed and cytology with Zeil-Nelsen staining was requested on the ultrasound aspiration; unfortunately, the patient follow-up was missed. However, there is a known history of admission to hospital for pulmonary tuberculosis treatment. Tuberculous lumbosacral junction spondylodiscitis is rare. 

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