Case Report Melioidotic Spondylitis Mimicking Tuberculous Spondylitis

A 52-year-old man came to hospital with the chief complaint of backache for 4 months. The patient had had diabetes mellitus for 9 years. He had frequently traveled to northeastern Thailand. Four months prior to admission, he suffered from backache. The pain progressively increased in 2 months before admission with fever, weakness of both legs and difficult walking and urine voiding. Physical examination revealed body temperature 38°C, tenderness at T8 to T9 vertebrae, paraparesis with sensory loss (pinprick sensation) below T9 vertebral level. Both legs also showed increased deep tendon reflex, positive clonus and Babinski sign. Investigation showed hemoglobin 15.1 g/1, white blood cells 6,300 /mm with neutrophils 82.4% lymphocytes 14%, monocytes 3.6%, platelets 105,000 /mm2• Blood chemistries showed fasting plasma glucose 262 mgl dl, blood urea nitrogen 16 mg/dl, creatinine 1 mg/dl. Electrolytes showed Na 138 mEq/1, K 3.6 mEq/1, Cl 101 mEq/1, HC0 3 21 mEq/1. Catheterized urine showed specific gravity 1.030, pH 5, red blood cells 30/hpf, white blood cells 8/hpf. Anti-HIV was negative. Chest film showed loss of delination of T9 vertebral body with a paravertebral soft tissue mass (Fig 1). X-ray of the thoraco-lumbar spine showed bony destruction of T9 vertebral body with loss of end plate and narrow of disc space between T9 and Tl 0 vertebrae (Fig 2). Computerized scan showed bony destruction of T9 vertebra with paravertebral soft tissue swelling and epidural abscess (Fig 3). The provisional diagnosis was tuberculous spondylitis with epidural abscess with