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Contrast-enhanced T1 (A) and T2-weighted (B) magnetic resonance imaging of the lumbar spine with evidence of chronic osteomyelitis at L3-L4 with large epidural phlegmon (arrows) and multiple small epidural abscesses resulting in high grade spinal stenosis with spinal cord compression.
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Repeat MRI of the lumbar spine revealed progressive osteomyelitis at L3-L4 with epidural abscess causing spinal cord compression (Figure 1).
Brown-Brenn stain of L3-L4 vertebral bone showing intracellular Gram-negative coccobacillary bacteria (arrow) consistent with Coxiella burnetii within the cytoplasm of histiocytes (magnification, 1000x).
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Surgical pathology of vertebral bone demonstrated osteomyelitis, granuloma, and intracellular Gram-negative coccobacilli (Figure 2).