Sacral Brodie's abscess in a patient with hereditary spherocytosis

Brodie's abscess is a subacute form of osteomyelitis typically seen in the metaphysis of long bones. Its occurrence in the sacrum is extremely rare. We report a case of Brodie's abscess involving the S2 vertebra in a male in his early 30s with hereditary spherocytosis, who presented with chronic low back pain without systemic signs of infection. Imaging revealed a well-defined, sclerotic lesion in S2 suggestive of chronic osteomyelitis. A minimally invasive biopsy and curettage was performed. Intraoperative findings suggested early infection, though cultures were negative. Histopathology showed trabecular bone with marrow spaces containing either haematopoietic cells or fibrous tissue, indicating healing. The patient received targeted antibiotic irrigation and a short oral antibiotic course. At 1-year follow-up, he was asymptomatic with complete radiological resolution. This case of isolated sacral Brodie's abscess highlights the importance of early imaging and clinical suspicion in atypical spinal infections, especially in patients with haematological disorders that may obscure typical signs.