intermittent fevers of 11 weeks’ duration
and
new-onset back and leg pain

multilevel degenerative changes

CT scan

tumor

no cortical erosion

MRI

not bacterial osteomyelitis or diskitis (disk-space infection)

gout

Vasculitis

Sarcoidosis

Pyogenic infections

Granulomatous Infections

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

Brucellosis

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.

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.

endocarditis

She had an outflow murmur, possibly originating at the aortic valve.

no evidence of infection

a neoplasm is unlikely to spread between vertebrae and to the disk space and surrounding soft tissue

would be more localized

no the anatomical abnormalities present in this case

can affect lymphatic tissue and can be present in bone