Lumbar Tuberculous Spondylodiscitis with Abscess Formation

A 58-year-old man presented to the emergency department

with severe lumbar pain that had persisted for the previous 10

days. He had a known history of heart valve disease, but no history

of surgery. Physical examination revealed restricted vertebral

movement and hepatomegaly.

Laboratory investigations revealed an elevated white cell

count (13.45×103

/µL), C-reactive protein (CRP) (84.78 mg/L),

and erythrocyte sedimentation rate (63 mm/h). Additionally, the

patient’s interferon-gamma release test was positive. Based on

these findings, empiral ceftriaxone therapy was administered.

Acid-resistant bacilli were not detected in the patient’s

sputum. Rose Bengal, the Wright agglutination test, and Brucella

immunoglobulin (Ig)M and IgG tests were negative.

The patient’s thoracolumbar magnetic resonance image (MRI)

is shown in Figure 1. Unfortunately, the abscess dimensions were

unsuitable for drainage.

After 20 days of antibacterial therapy, no clinical or laboratory

improvements were observed. Therefore, antituberculosis therapy

with isoniazid 300 mg/day, rifampicin 600 mg/day, ethambutol 2

g/day, and pyrazinamide 2 g/day.

During the first month of treatment, CRP decreased to 8.57

mg/L and erythrocyte sedimentation rate to 27 mm/h. The

abscess formation contracted significantly by the ninth month of

antituberculosis therapy. Due to the insertion of a pacemaker, an

MRI could not be performed during this follow-up. However, the

patient’s lumbar computed tomography scan is shown in Figure 2.

Tuberculous spondylodiscitis can be challenging to diagnose

due to atypical presentation1

. Distinguishing it from pyogenic

spondylodiscitis is crucial because of their different and specific

treatment requirements2

.