PMC5779791_01
Computed tomographic images of the entire spine. Coronal (A) and sagittal (B) images showed that worm-eaten and osteolytic bony destruction spread over noncontiguous multilevel vertebral involvement in cervical, thoracic, lumbar, and sacral, with the similar lesions at the posterior elements. And there was no evidence of the obvious collapse of the adjacent vertebral body.
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F1
Whereas further computed tomographic of whole spine images surprizing us, indicated multifocal diffuse lesions located in cervical, thoracic, lumbar, and sacral vertebrae showing multiple level worm-eaten and osteolytic bony destruction, including C5, T1-T5, T7-T12, L1-L5, and S1 (Fig. 1).
Computed tomographic images of T4 and T11 segments revealed that osteolytic lesions are located at the joins of the vertebrae, adjacent ribs, and the posterior elements (neural arch and spinous processes) with the paraspinal soft tissue edema.
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F2
There was a paravertebral mass at the T9-T10 level (Fig. 2).
Magnetic resonance imaging (MRI) of the entire spine. Sagittal (A-C) T2-weighted image images STIR showed that heterogeneous mixed high-intensity changes at C3, C5, T1-T5, T7-T12, L1-L5, and S1 segments. Sagittal T2W image STIR showed hyperintensity of L1 and L3 vertebral body with associated heterogeneous signal extending anteriorly into the posterior region. There was also fusiform paraspinal abscess involving the T9/T10 level and small epidural abscess at the posterior of the spinal canal at T7. The disc spaces and height of vertebrae are relatively preserved.
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F3
Besides, the epidural abscess at the posterior of the spinal canal at T7 and T12 compressed the dural sac distinctly and a fusiform paraspinal abscess located at T9-T10 without obvious collapse of the adjacent vertebral body (Fig. 3).
Histopathology photomicrographs of the excised specimen. (A) Low power view showed epitheloid granulomata (H&E, original magnification x40). (B) (H&E, original magnification x100) showed abundant caseous necrosis with multinucleated giant cells, considering tuberculous infection.
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F4
Pathological examination indicated a chronic granulomatous inflammation with abundant caseous necrosis, considering tuberculous inflammation (Fig. 4).
Computed tomographic images of the entire spine at 18-month follow-up. Coronal (A) and sagittal (B) showed that all the worm-eaten and osteolytic lesions of bone destroy were healed apparently including the vertebral bodies and posterior elements. And there was no evidence of recurrence.
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F5
At 18-month follow-up, all the worm-eaten and osteolytic bony lesions were healed apparently, showing the disappearance of paravertebral and epidural abscess, and there was no evidence of recurrence on CT scan (Figs. 5 and 6).
Computed tomographic images of T4 and T11 segments at 18-month follow-up. Compared to Fig. 2, the imaging revealed that osteolytic lesions are healed apparently at the joins of the vertebrae, adjacent ribs, and the posterior elements (neural arch and spinous processes) without the paraspinal soft tissue edema.
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F6
At 18-month follow-up, all the worm-eaten and osteolytic bony lesions were healed apparently, showing the disappearance of paravertebral and epidural abscess, and there was no evidence of recurrence on CT scan (Figs. 5 and 6).