A 61-year-old woman is transferred from a local long-term acute care facility to your hospital for evaluation of severe back pain. She was at the long-term care center recovering from methicillin-resistant Staphylococcus aureus sepsis, for which she required a lengthy ICU stay and prolonged mechanical ventilation with subsequent tracheostomy and gastrostomy tube placement. Medical history is significant for diabetes, hypertension, and rheumatoid arthritis.
Physical examination shows a frail woman in no obvious distress. Her vital signs are normal. She does have moderate palpable tenderness in the lumbar spine, as well as some prominence in the left paraspinous area. She is able to move all of her extremities and, despite being deconditioned, is neurologically intact. Radiograph of the lumbar spine is shown.
Answer
The radiograph shows significant osteopenia. Of note is a compression deformity of the L3 vertebral body. The superior endplate of L3 is not well defined, and there is significant narrowing of the L2-L3 disk space. Such findings point to the possibility of an acute inflammatory process such as diskitis or osteomyelitis. These diagnoses were later confirmed by MRI with contrast enhancement, which also revealed a psoas abscess.
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