Case 220

 An eighty one-year-old male presented in our hospital with a referring letter and laboratory data from a local clinic. It said high fever and high values of CRP 29.7 mg/dL, white blood cells 16940/mm³, neutrophils 89%, total bilirubin 2.63mg/dL, AST 104 U/L, ALT 52 U/L, choline esterase 119 U/L, BNP 618pg/dL. He was a heavily-alcohol drinker with strong whisky 180 mL /day. Under suspicious biliary duct inflammation, our clinician asked him to take abdomen CT at admission (Figs 1, 2). The following day, he took lumbar vertebra MRI (Figs 3-6) for further investigation.

What is your diagnosis ?

1.　Metastatic bone tumor

2.　Multiple myeloma

3.　Psoas muscle abscess

4.　Erector lumbar muscle abscess

5.　Epidural abscess

answer

2021.2.3