case_images: PMC8046463_01
case_images: Lumbar spine X-ray revealed paradiscal osteopenia with decreased disc space between L5 and S1.
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case_images: F1
case_images: Radiologically, lumbar spine X-ray (Fig. 1) revealed pars discal osteopenia with decreased disc space between L5 and S1.
case_images: Magnetic resonance imaging revealed signal intensity changes suggestive of patchy marrow edema present over the L2 to S1 vertebra up to the upper two-third of the sacral ala, midportion of sacrum and right iliac bone with associated epidural, pre- and paravertebral soft-tissue extension along bilateral psoas muscles.
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case_images: F2
case_images: In view of persistent neurological deficit, pain, a team discussion with oncologists, infectious disease specialists, and orthopedic spine team, Magnetic resonance imaging (MRI) (Fig. 2) revealed signal the final decision was made to do a surgical decompression and biopsy from the affected areas.
case_images: Nuclear positron emission tomography scan showed an increase in radiotracer concentration involving L2-L5 vertebra, S1 vertebra, right sacroiliac region, and right ilium.
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case_images: F3
case_images: X-ray revealed diffuse osteopenia with patchy sclerosis and degenerative changes with lami-nectomy defects.
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case_images: F4
case_images: Contrast magnetic resonance imaging showed patchy areas of marrow signal abnormality L1, L2, L4, and L5 vertebra and adjoining endplates of L5, S1, and S2 segments. Ring enhancing lesions at L2, L3 levels. Enhancing hyperintense signals in posterior paraspinal muscles at L1 and L2. Tiny enhancing lesions on the right ilium.
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case_images: F5
case_images: Contrast MRI (Fig. 5, 6, 7) showed patchy areas of marrow signal abnormality L1, L2, L4, and L5 vertebra and adjoining endplates of L5, S1, and S2 segments.
case_images: Contrast magnetic resonance imaging showed patchy areas of marrow signal abnormality L1, L2, L4, and L5 vertebra and adjoining endplates of L5, S1, and S2 segments. Ring enhancing lesions at L2 and L3 levels. Enhancing hyperintense signals in posterior paraspinal muscles at L1 and L2. Tiny enhancing lesions on the right ilium.
case_images: JOCR-11-72-g006.jpg
case_images: PMC8046463_01_JOCR-11-72-g006.jpg
case_images: F6
case_images: Contrast MRI (Fig. 5, 6, 7) showed patchy areas of marrow signal abnormality L1, L2, L4, and L5 vertebra and adjoining endplates of L5, S1, and S2 segments.
case_images: Contrast magnetic resonance imaging showed patchy areas of marrow signal abnormality L1, L2, L4, and L5 vertebra and adjoining endplates of L5, S1, S2 segments. Ring enhancing lesions at L2 and L3 levels. Enhancing hyperintense signals in posterior paraspinal muscles at L1 and L2. Tiny enhancing lesions on the right ilium.
case_images: JOCR-11-72-g007.jpg
case_images: PMC8046463_01_JOCR-11-72-g007.jpg
case_images: F7
case_images: Contrast MRI (Fig. 5, 6, 7) showed patchy areas of marrow signal abnormality L1, L2, L4, and L5 vertebra and adjoining endplates of L5, S1, and S2 segments.
case_images: Positron emission tomography scan shows lytic areas over L2 to L5 vertebrae and sacral ala and ilium possibility of infective etiology more likely atypical Kochs/brucella/Fungal or any unusual bacterial infection.
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case_images: F8
case_images: PET scan (Fig. 8, 9, 10) shows lytic areas over L2 to L5 vertebrae and sacral ala and ilium possibility of infective etiology more likely atypical Kochs/brucella/Fungal or any unusual bacterial infection.
case_images: Positron emission tomography scan shows lytic areas over L2 to L5 vertebrae and sacral ala and ilium possibility of infective etiology more likely atypical Kochs/brucella/Fungal or any unusual bacterial infection.
case_images: JOCR-11-72-g009.jpg
case_images: PMC8046463_01_JOCR-11-72-g009.jpg
case_images: F9
case_images: PET scan (Fig. 8, 9, 10) shows lytic areas over L2 to L5 vertebrae and sacral ala and ilium possibility of infective etiology more likely atypical Kochs/brucella/Fungal or any unusual bacterial infection.
case_images: Positron emission tomography scan shows lytic areas over L2 to L5 vertebrae and sacral ala and ilium possibility of infective etiology more likely atypical Kochs/brucella/Fungal or any unusual bacterial infection.
case_images: JOCR-11-72-g010.jpg
case_images: PMC8046463_01_JOCR-11-72-g010.jpg
case_images: F10
case_images: PET scan (Fig. 8, 9, 10) shows lytic areas over L2 to L5 vertebrae and sacral ala and ilium possibility of infective etiology more likely atypical Kochs/brucella/Fungal or any unusual bacterial infection.
case_images: Histopathology revealed clumps of basophilic filamentous bacteria in a vaguely rosette-like configuration surrounded by acute inflammatory cells, characteristic of actinomycosis.
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case_images: F11
case_images: Histopathology (Fig. 11, 12) revealed clumps of basophilic filamentous bacteria in a vaguely rosette-like configuration surrounded by acute inflam-matory cells, characteristic of actinomycosis.
case_images: Histopathology revealed clumps of basophilic filamentous bacteria in a vaguely rosette-like configuration surrounded by acute inflammatory cells, characteristic of actinomycosis.
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case_images: PMC8046463_01_JOCR-11-72-g012.jpg
case_images: F12
case_images: Histopathology (Fig. 11, 12) revealed clumps of basophilic filamentous bacteria in a vaguely rosette-like configuration surrounded by acute inflam-matory cells, characteristic of actinomycosis.
case_images: X-ray showed a significant reduction in marrow changes and reduction in osteopenia in lumbar and sacral areas.
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case_images: F13