Radiology Review

Man with Debilitating Back Pain

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A 54-year-old man presents with a complaint of a two-week history of severe low back pain. He denies any injury or trauma. The pain is so severe that it limits his ability to walk. He states he had similar episodes earlier this year, some of which required him to be admitted to the hospital. His medical history is significant for hypertension, diabetes, and coronary artery disease. He admits to recently having subjective fever and chills, as well as some nausea. Physical exam shows a deconditioned male who is uncomfortable but in no obvious distress. He is afebrile, with a blood pressure of 92/57 mm Hg, a heart rate of 97 beats/min, and a respiratory rate of 20 breaths/min. He has mild tenderness to his lumbosacral area; no deformity, step-off, or crepitus is appreciated. He does have decreased range of motion in his lower extremities, although this may be a consequence of his back pain. While trying to pull up his previous medical records, you order some basic labwork and lumbar spine radiographs. Lateral lumbar spine radiograph is shown; what is your impression?


 

ANSWER
The radiograph demonstrates generalized degenerative changes. Of note are fairly significant destructive changes in the endplate at the L3-4 level. Such changes are generally consistent with osteomyelitis and diskitis.

On further questioning, the patient reported that when he was admitted previously, he was told that he had an “infection in his back” and was treated with IV antibiotics. This patient was again admitted for additional workup and treatment.

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