COS Quiz 6

August 2014

Case history

• 59 yr old male

• Low back ache

• Radicular pain for quite some time

Roentgenogram

MRI

MRI

• Underwent minimally invasive discectomy at one center…L4-5 and L5-S1

• 5 days later he was complaining of pain again

Rpt MRI

• Thought of infection • Send to another centre• There he was re explored • Found nothing • Gave antibiotics , antidepressants analgesics• HPE—acute on chronic inflamation• His pain persisted • ESR – 90 mm/hr• TC, DC –Nl• Gradually he developed inability to walk , severe

pain at night, leg cramps, weakness of both lower limbs

• Taken to another centre– but the same treatment

Follow up MRI

ESR -120mm/hr

X-ray– at 8 months

ESR reduced to 90 mm/hr

Present MRI

• Biopsy from a fresh site taken at this time

• HPE—acute on chronic infection

Diagnosis ?

• 1.M. Tuberculosis infection

• 2.Disseminated malignancy

• 3.Fungal osteomyelitis

• 4. Brucellosis

• 5.Ochronosis

• 6.None of the above