PMC5548693_01
There was a purulent region on the left sinciput.
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There was a purulent region on the left sinciput (Fig. 1) and her right knee was slightly red, swollen, and painful.
(A) Computed tomography (CT) image showing osteolytic changes in the vertebrae and abscesses adjacent to the T3 vertebral body. (B) A CT image showing an improvement at 21 months after treatment with rifampicin, ethambutol, and clarithromycin.
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T3 vertebral body (Fig. 2A). 18-fluorine-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) examination showed multiple lesions with an intense FDG accumulation in the abscesses adjacent to the T3 vertebral body and various bones, such as the skull, sternum, clavicles, ribs, vertebral columns, scapulae, pelvic bones, bilateral humerus, and thigh bones. These findings of osteolytic changes in the bones of the whole body more strongly suggested the presence of metastatic carcinomas and blood diseases, such as malignant lymphoma and multiple myeloma than the existence of bacterial infections. August 2014. After completing the first treatment regime, she was prescribed additional treatment with 3 drugs (RFP, EB, and CAM) from September 2014 to August 2016, which resulted in symptomatic relief and a radiological improvement (Fig. 2B).
Sagittal T2-weighted image showing several hyperintense signals in the vertebral bodies, their surroundings, and intervertebral spaces.
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T2-weighted imaging (WI) and diffusion-WI (DWI) revealed several hyperintense signals in the vertebral bodies, their surroundings, the intervertebral spaces, which was consistent with osteomyelitis and spondylitis (Fig. 3), and in the right thigh bone and tibia (Fig. 4).