The sagittal MRI views of the vertebral column demonstrate destruction of T8 and 9 consistent with osteomyelitis. The micrograph reveals granulomatous inflammation with caseous necrosis, epithelioid cells, and a Langhans giant cell. Acid fast bacilli were identified, and Mycobacterium tuberculosis was cultured. Thus, this is a case of Pott's disease--tuberculous osteomyelitis of the spine. The mid-thoracic region is typically affected, with the tubercle bacilli reaching this location hematogenously or via pleural lymphatic connections to paravertebral lymph nodes. Bony destruction can lead to collapse with impingement upon the spinal cord, as seen here, and surgical stabilization may be necessary, along with multi-drug antitubercular therapy.
There were 159 correct responses out of 226 total entries for case 44.
| Our winner is: Dr. Adokiye S. Benebo of Lagos, NIGERIA
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