45 year old gentleman presented with vague low back ache. An MRI was asked for to rule out lumbar disc disease.
- STIR hyperintense signals are seen involving the L3 and L4 vertebral bodies.
- breach of the anterior half of superior end plate of L4 with a fluid signal intensity traversing the L3-4 disc superiorly to extend to the inferior end plate of L3.
- anteriorly it extends subligamentous to the right of midline mildly displacing the IVC anteriorly.
- no involvement of psoas muscles.
- no posterior extension into epidural space.
- no other vertebral joint involvement.
- rest of the intervertebral discs and lumbar vertebrae are normal.
- Imaging features are typical of spondylodiscitis.
- This patient is of Mediterranean origin and lab investigations revealed positivity for Brucellosis.
- Brucella spondylodiscitis has a predilection for lumbar spine and tends to present late in view of vague symptoms.