Young woman with lasting back pain

Images in medicine


    A previously healthy Norwegian-Pakistani woman in her late 20s was hospitalised because of listlessness. She had had pain lower back pain for a year and had herself discovered a lump in her flank. On admission she was in slightly poor general condition and was tender to palpation over the lower part of her spine. A painful tumour was found in her right flank.

    She had an erythrocyte sedimentation rate of 49 mm/h. Other general blood tests, including an HIV test, were normal. Both chest X-ray and urine culture for mycobacteria were negative. MR abdomen revealed findings as for spondylodiscitis at level Th11/Th12 with a large depression abscess in the right m.psoas (left). The abscess measured approximately 14 cm craniocaudally and extended caudally to the level of the L5 corpus vertebrae. A section through the abscess is seen on the right. Microscopy of the abscess material revealed no findings of acid-resistant rods. Culturing and polymerase chain reaction revealed findings of Mycobacterium tuberculosis. About 350 ml pus was drained off and long-term tuberculostatic treatment was started. The woman is being monitored regularly through outpatient follow-up.

    Vertebral affection may be the first manifestation of tuberculosis. This is an important differential diagnosis, particularly in a patient who comes from a high endemic area, as was the case for this young woman. Common symptoms of vertebral tuberculosis are back pain, weight loss, fever and tiredness.

    The patient has consented.


    Recent Articles

    Made by Ramsalt Using Ramsalt Media