Presentation
HIV positive coming in with long term history of constitutional symptoms and back pain. Recent weakness of both legs with loss of bladder and bowel control
Patient Data
There is destruction of the L1 and L2 vertebral bodies with associated paraspinal and bilateral psoas abscesses (L>R) There is retropulsion of the debri displacing/peeling off the posterior longitudinal ligament causing spinal stenosis and cauda equina compression at this L1/L2 level.
At C7/T1 level, there is destruction of the intervening disc with an associated paraspinal collection, which is extending inferiorly to the level of T5. The C6, C7, T1, T2, T3, T4 and T5 bodies demonstrate abnormal signal, with collapse of the T4 vertebral body causing mild kyphosis. There is also spinal stenosis and cord compression at this level.
Case Discussion
These findings are consistent with Tuberculous spondylitis, which typically involves the vertebral bodies. Disc involvement is typically late in this process.