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Diagnosis: Spondylitis Tuberculous spondylitis tends to be seen in the lower thoracic spine while pyogenic spondylitis tends to involve the lumbar spine. In the United States TB is typically seen in middle aged patients, whereas pyogenic spondylitis tends to occur in more elderly patients and those who are predisposed including alcoholics, IV drug addicts, and other immunosupressed patients. Most cases of TB spondylitis involve two adjacent vertebral bodies. Non-contiguous involvement may also be seen. In addition, many patients with TB spondylitis have associated abscesses which have spread into the psoas muscles. The classic appearance of TB spondylitis includes a destructive soft tissue mass with psoas abscess, pathologic vertebral body collapse and a gibbus deformity. Pyogenic osteomyelitis tends to not have the degree of destruction associated with tuberculosis perhaps because TB has a more indolent course. The main differential considerations here include TB versus pyogenic/bacterial spondylitis. Neoplasm is also a consideration but is less likely due to the presence of the severe deformity. This patient has a history of spinal trauma as well as IV drug abuse and was lost to follow up. The true etiology remains indeterminate. Related Cases
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