2. CASE PRESENTATION
A 72-year-old man was diagnosed with pyogenic spondylitis, low back
pain, and fever. After unsuccessful control of the inflammation with the
use of antibacterial medication for more than 12 months, the patient was
referred to our department. At the first visit to our department, the
patient had no fever, low back pain, or abnormal neurological deficits.
Plain radiographs showed spinal ankylosis from T4 to T11 and from T12 to
L1. Sagittal MRI demonstrated that the T11–12 vertebral bodies showed
heterogeneously high signal intensity on both T1-weighted images (WI)
and T2WI. The intervertebral disc at T11–12 was clearly enhanced on
gadolinium (Gd)-enhanced T1WI (Figure 1). Sagittal reconstructed
computed tomograms (CT) showed diffuse idiopathic skeletal hyperostosis
between T9 and L3 without obvious vertebral destruction (Figure 2). T11
and T12 vertebral bodies indicated osteosclerosis. A chronic pyothorax
was also found on a chest CT scan but was not indicated for therapeutic
intervention by a respiratory physician. CT-guided biopsy of the T11–12
intervertebral disc revealed a negative culture study with a
histopathological diagnosis of chronic inflammation. The antibiotic
medication was discontinued because the patient was asymptomatic, and
the patient’s serum C-reactive protein (CRP) value ranged between 1 and
2 mg/dL.
One year later, the patient was admitted to the Department of
Respiratory Medicine with rapidly deteriorating pyothorax and pneumonia.
Thoracic drainage was performed, and Pseudomonas aeruginosa was
detected. CT showed marked destruction of the T11–12 vertebral bodies,
which indicated “rim enhancement” on Gd-enhanced T1WI MRI (Figure 3).
We diagnosed the patient with progressive pyogenic spondylitis and
planned surgical treatment after improvement of pyothorax and pneumonia.