Over the preceding 3 months, he had gradually developed symmetrical masses on either side of the thoracic spine (A and B). He denied any respiratory symptoms, fever, sweats or weight loss. On examination, he was afebrile and both masses were fluctuant but not tender or inflamed. Spinal movement was unrestricted and no features of spinal cord compression were present.
Blood tests showed a normal white cell count and differential, a C-reactive protein level of 180 mg/L (reference range, 0–4 mg/L), and an erythrocyte sedimentation rate of 64 mm/h (reference range, 0–15 mm/h). HIV serology was negative. Magnetic resonance imaging of the thoracic cord showed large, bilateral collections within the rectus spinae muscles extending between T3 and T10, and destruction of the spinous process of T5. There was also high signal in the facet joints at this level, suggesting an infection arising from them (C).
- Simon Goldenberg1
- Nicholas Price2
- Department of Infection, Guy’s & St Thomas’ NHS Foundation Trust, London, UK.