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Back pain and oedematous Schmorl node: a diagnostic dilemma
Aakriti Pandita1, Nikhil Madhuripan2, Rocio M Hurtado3
1Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA.
BMJ Case Reports
|May 25, 2017
Summary
A rare case of spinal tuberculosis (TB) was diagnosed in a young woman presenting with chronic low back pain. The diagnosis was delayed due to an unusual early lesion, a Schmorl node with edema, not previously associated with spinal TB.
Area of Science:
- Spinal Tuberculosis
- Radiology
- Infectious Diseases
Background:
- Spinal tuberculosis (TB) diagnosis can be delayed despite advanced imaging.
- Chronic low back pain in young adults warrants thorough investigation.
- Previous treatments for inflammatory arthropathies were ineffective.
Observation:
- A 26-year-old female presented with over a year of progressive low back pain.
- Lumbar MRI revealed a Schmorl node with surrounding marrow edema at L4.
- A biopsy of the lesion confirmed culture-positive spinal tuberculosis.
Findings:
- The Schmorl node with edema was an unusual early finding in spinal TB.
- This specific lesion has not been previously reported in association with spinal TB.
- Delayed diagnosis of spinal TB remains a clinical challenge.
Implications:
- Highlights the importance of considering spinal TB in cases of chronic back pain, even with atypical imaging findings.
- Suggests that Schmorl nodes with edema may be an under-recognized early sign of spinal TB.
- Emphasizes the need for continued vigilance and diagnostic accuracy in spinal infections.
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