A 22-year-old man comes to the office due to 3 months of progressive back pain. He has also had intermittent subjective fever. The patient emigrated from Nepal for a master's program 6 months ago. He has no other medical conditions, takes no medication, and does not use tobacco, alcohol, or illicit drugs. Temperature is 38.3 C (100.9 F), blood pressure is 122/78 mm Hg, and pulse is 84/min. BMI is 19 kg/m². Tenderness is noted over the lumbar spine; flexion, extension, and rotation of the spine are limited due to pain and muscle spasm. MRI of the lower spine reveals partial destruction of the anterior portion of the L1-L3 vertebral bodies and a fluid collection beneath the anterior longitudinal ligament. Which of the following is the most likely diagnosis?

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Quizplus · Accepted Answer

Eductional Objective: Mycobacterium tuberculosis spondylitis (Pott disease) is usually the result of hematogenous seeding of vertebrae from primary pulmonary infection.  Manifestations typically arise months or years later (due to reactivation) and include chronic, progressive back pain, fever, and radiographic evidence of vertebral bone destruction and fluid collection.

A 22-Year-Old Man Comes to the Office Due to 3