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Low back pain with fever, weight loss, and elevated CRP.
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Narrowing of L4-L5 disc space with a low signal on T1, high signal on T2/STIR of the L4, and L5 vertebral bodies with enhancement on postcontrast sequences indicating bone marrow edema. There is an intradiscal abscess extending to the neighboring endplates with thickening and enhancement of the prevertebral soft tissue containing small abscesses formation. Edematous infiltration with abscesses formation the left psoas muscle.
MRI features consistent with an L3-L4 spondylodiscitis with small abscess formations. , that was confirmed by CT-guided biopsy 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.