case_images: PMC10559415_01
case_images: Radiology: Spondylodiscitis with epidural and paraspinal abscess. (a1-a3) Sagittal T2WI of the lumbar spine shows multiple abnormal marrow signals involving the vertebral body and endplates of L2, L4, L5, and S1 with disc degeneration at L5/S1. There is an associated abnormal large ventral and dorsal epidural and paraspinal components compressing the thecal sac and cauda equina nerve roots. Sagittal (b1-b3) and axial (c1 and c2) WI show abnormal post contrast enhancement of the vertebral bodies and end-plated and marginal enhancement of the large epidural and paraspinal abscesses with extension against the neural foramen. (d) Sagittal T2WI of the cervical spine shows abnormal signal intensity of the upper cervical spine C2/3 and T5 suggesting noncontiguous infection. (e) A sagittal post contrast study shows abnormal vertebral with associated mild prevertebral and ventral epidural enhancement suggesting an infective process.
case_images: SNI-14-315-g001.jpg
case_images: PMC10559415_01_SNI-14-315-g001.jpg
case_images: F1
case_images: At the same level, there was a partially imaged tubular branching, abnormal bright T2/fluid signal with an epicenter at the neural foramina encircling the L4 and L5 vertebral bodies anteriorly [Figure 1].
case_images: (a and b) Epidural and subdural multi-layered inflamed nonpurulent soft-tissue/phlegmon perforating the dura and extending into the subdural space. (b and c) A thick, inflamed, and intact arachnoid layer. (d) White-yellow liquor puris purulent fluid pus discharge contained within a thin encapsulated membrane.
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case_images: PMC10559415_01_SNI-14-315-g002.jpg
case_images: F2
case_images: In addition, a paraspinal muscle abscess extension noted [Figure 2].
case_images: Pathology: low power x4 (a) and high power x20 (b), shows a well-formed necrotizing (caseating) granuloma with central necrosis, surrounded by epithelioid histiocyte and lymphocyte. Special stains (not shown here) for Mycobacterium [Ziehl-Neelsen stain (ZN)] and fungal infection [Grocott methenamine silver (GMS) stain] are negative (these studies are for screening purposes. Negativity for these stains does not rule out the possibility of such infection).
case_images: SNI-14-315-g003.jpg
case_images: PMC10559415_01_SNI-14-315-g003.jpg
case_images: F3
case_images: Acid-fast bacilli (AFB) were negative for Mycobacterium [Figure 3].