Disseminated M. bovis Infection and Vertebral Osteomyelitis following Immunotherapy for Bladder Cancer

Figure 1

(a) An axial T2-weighted MRI image of morphological changes at the L1-L2 level presumed to be from degenerative process but difficult to distinguish from early infection. (b) A sagittal STIR MRI image showing multilevel degenerative changes resulting in severe canal stenosis particularly at the L2-L3 and L3-L4 levels. The morphological changes observed in Figure 1(a) are also visible. (c) An axial T2-weighted MRI image showing a heterogenous left paraspinal spinal mass with solid and cystic components. These findings raise concern for a potentially neoplastic process superimposed on an atypical infection. (d) A sagittal T1-FLAIR MRI image showing progressive, extensive degeneration at the L1-L2 and L3-L4 levels since prior study, suggesting infectious etiology. (e) An axial T1 FS post-MRI image showing 2 new small nonenhancing abscesses within the left psoas muscle and right L2-L3 paraspinal phlegmon. This epidural phlegmon, together with the microabscesses, caused an apparent impingement of the right L2 nerve at the right proximal margin of the right L2-L3 neural foramen. (f) A sagittal T1 MRI image showing L1-L2 discitis and vertebral, endplate osteomyelitis of L2.

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