This 76-years old man presented with backache and fever.
MRI (T1W sag and T1W post-contrast axial) showed a classic infectious spondylitis. The working diagnosis was tuberculosis, but at this age, in this region, without an obvious abscess, a bacterial cause should be considered. The CT scan at the time of the biopsy showed typical findings with sclerosis.
I did a biopsy with an 18G coaxial biopsy gun and it showed Enterococcus fecalis.
He was put on appropriate treatment and 3 months later, the follow-up MRI (T1W sag and T2W axial) showed improvement.
Basic Rules: Every infectious spondylitis in India is not tuberculosis and every infectious spondylitis must be biopsied.