intermittent fevers of 11 weeks’ duration and new-onset back and leg pain
intermittent fevers of 11 weeks’ duration
new-onset back and leg pain
multilevel degenerative changes
no cortical erosion
no evidence of infection
a neoplasm is unlikely to spread between vertebrae and to the disk space and surrounding soft tissue
not bacterial osteomyelitis or diskitis (disk-space infection)
would be more localized
no the anatomical abnormalities present in this case
can affect lymphatic tissue and can be present in bone
would have expected more flagrant clinical signs of systemic inflammatory response and of local impingement on the spinal cord or nerves
5 years in a refugee camp
high risk of the acquisition of tuberculosis
It has been suggested that the constellation of back pain, elevations in the erythrocyte sedimentation rate and the level of serum C-reactive protein, a history of previous tuberculosis, and involvement of posterior spinal elements on imaging is pathognomonic of tuberculosis
On MRI, a well-defined abnormal paraspinal signal and a thin, smooth abscess wall suggest tuberculous infection.
unpasteurized camel’s milk
Fever is the primary symptom of brucellosis, often with chills
osteoarticular disease is the most common complication when focal infection is diagnosed
Brucellosis often involves the spine
Marked destruction of vertebral bodies, usually in the thoracic or thoracolumbar area, is more common in tuberculosis, whereas disk destruction is seen more often in brucellosis.
She had an outflow murmur, possibly originating at the aortic valve.