Case 14
Clinical History:
Case Presentation:
A 63 year-old man presented initially with vague back pain for three to four years. A compression fracture at L1 due to osteoporosis was diagnosed and treated by physical therapy. Soon afterwards he developed motor weakness and dysesthesia in both lower limbs. A myelogram showed a tumor "mass" at T9. A right thoractomy and debridement at the T8-T9 region yielded granulation tissue and acid fast bacilli. Three days later he was started on antituberculous therapy. One month later, the patient returned for elective T6-11 spinal fusion with autogenous rib grafts and placement of Harrington rods.
Several months later, the patient complained of severe back pain in the mid-dorsal spine. Physical examination was unremarkable except for point tenderness in the mid-dorsal spine. Lab results showed normal WBC, low RBC, low hematocrit, and persistently elevated ESR of 105 mm/hr., which never went below 100 mm/hr.
Images
Follow up
Two months later the patient complained of vague low back pain.
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J. Anthony Parker, MD PhD, jap@nucmed.bih.harvard.edu
