A 49-year-old woman complaining of thoracic spine pain for 18 months was admitted to the hospital for evaluation. The pain was accompanied by profuse sweating but she did not report any fever.
Physical examination revealed tenderness of the affected area on percussion, as well as pain and limitation of motion.
Erythrocyte sedimentation rate (ESR) was 86 mm (first hour). Chest x-ray showed destruction of the lower part of the body of the eighth thoracic vertebra. Magnetic resonance imaging of the thoracic spine showed pathology of the T8-T9 intervertebral disk and destruction of the T8 vertebral body (Figure 1). Computed tomography scan-guided fine needle aspiration of the affected disc was performed. Gram stain and culture of the obtained specimens for common microorganisms and Brucella species were negative. Serology tests for brucellosis were also negative. In addition, Ziehl-Neelsen stain, polymerase chain reaction (PCR), and culture for Mycobacteria were negative. Because of continuing symptoms and lack of diagnosis the patient underwent a vertebrectomy and substitution of the eighth thoracic vertebra with Moss titanium cylinder filled-up with auto-bone grafts. The stabilization was completed using the Kaneda system (Figure 2).
Matthew E. Falagas, MD, MSc, DSc
George Peppas, MD, PhD
Panayiotis J. Papagelopoulos, MD, DSc
Konstantinos Rellos, MD