Case 153

 A seventy two year-old male came to our hospital routinely once a month for lumbago and painful heel. Three days before, a sister in law found him lying at his rice field. He mentioned lumbago was worsening. Somehow, he went to the orthopedist in our hospital by himself at that day. Thereafter, because lumbago was too hard to bear walking, food was given by neighbors. The sister in law explained this situation by a phone to his sister, who asked the emergency to send him to our hospital. Medical findings showed tenderness at the para vertebral area of the L1 to L2 spine. Slight high fever of 37℃ level continued for a few days. Laboratory test revealed CRP 18.6 mg/dL, white blood cells 13040/mm³. He received lumbar spine MRI for further investigation (Figs. 1-3).

What is your diagnosis ?

1. 　Metastatic bone tumor

2. 　Multiple myeloma

3. 　Pyogenic spondylitis

4. 　Tuberculous spondylitis

5. 　Vertebral endplate flame

answer

2019.7.17