A 50-year-old woman was admitted to our clinic for low back pain, muscle spasm, and an inability to walk. She had attended different clinics due to low back pain for approximately one month without improvement in her symptoms. Physical examination revealed splenomegaly of approximately 1 cm and rales in the inferior lobes. The laboratory indicated a white cell count of 5.5 × 103/µL, C-reactive protein concentration of 55.2 mg/dL, sedimentation rate of 79 mm/h, and tuberculin skin test measuring 18 mm. She tested negative for serum tube agglutination and autoantibodies positive for Quantiferon test, and negative for acid resistant-bacillus in her sputum. Pulmonary computed tomography showed ground-glass opacity and incomplete-complete consolidation in the bilateral lungs (Figure 1). A 1 × 9-cm abscess was observed at the L4-S2 vertebral level in lumbar magnetic resonance imaging (MRI), with contrast involvement in post-contrast sections (Figure 2). Specimens were not taken from the abscess material. The patient was started on four-drug anti-tuberculous therapy (isoniazid 300 mg/day, rifampicin 600 mg/day, ethambutol 2 g/day, pyrazinamide 2 g/day). Lesion regression was observed in control MRI performed at nine months (Figure 3).
Spinal tuberculosis accounts for less than 1% of all tuberculosis cases1. Owing to MRI’s high sensitivity and specificity, it is a powerful diagnostic tool for the early diagnosis of tuberculous spondylodiscitis2. In cases where tuberculous agents cannot be grown in culture, appropriate radiological imaging methods should be applied. Thus,treatment can be initiated earlier and morbidity rates can be reduced.