Imaging in acute pyogenic spondylitis

A 51-year-old woman who was receiving 7.5 mg prednisone daily for sarcoidosis presented with low backache on the right side, fever, and chills 2 weeks after dental surgery. Examination revealed lower lumbar tenderness andrestricted movement. Blood cultures grew Streptococcus viridans but echocardiography failed repeatedly to demonstrate any evidence of infective endocarditis. Skeletal scintigraphy, including a pinhole image, revealed abnormal uptake in L5. Computed tomography (CT) showed a lytic lesion in the body of L5 and Tc-99m ciprofloxacin (Infecton) imaging demonstrated increased uptake in the lower lumbar region on the right. After several weeks of antibiotic therapy, the patient became afebrile and pain-free.