Presentation
History of low back pain with night sweats and low-grade fever.
Patient Data
Narrowing of L2-L3 disc space with a low signal on T1, high signal on T2 and STIR of the L2, and L3 vertebral bodies with enhancement on postcontrast sequences (bone marrow edema). Intradiscal abscess extending to the adjacent vertebral end plates. Thickening with enhancement of the paravertebral soft tissues as well as the anterior epidural space containing small abscess formations, compressing the thecal sac.
Moderate disc protrusion at L4-L5 and L5-S1.
Case Discussion
The clinical presentation and the MRI features are most consistent with L2-L3 spondylodiscitis with paravertebral and anterior epidural abscess formations, confirmed by CT-guided puncture-aspiration as tuberculous origin.
MRI is considered the modality of choice due to its very high sensitivity and specificity. It is also helpful to differentiate between pyogenic, tuberculous, and fungal origin, and to rule out a neoplastic process.
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