CASE HISTORY

The patient was admitted to hospital with low lumbar backache of several weeks duration. X-ray showed active tuberculosis of the 4th lumbar vertebra involving the intervertebral disc between it and 5th. He was treated by immobilization on a spinal frame but in spite of this his condition slowly deteriorated. After he had been in hospital a considerable time his liver and spleen became palpable and there was moderate albuminuria, indicating the onset of amyloid disease. A left psoas abscess developed and ultimately sinuses formed in the left groin and left buttock. He eventually died after a period of 15 months' immobilization in hospital. X-ray taken 6 weeks before his death show a destructive process involving the inferior and posterior aspect of the 4th lumbar vertebra with collapse of the disc between 4th and 5th lumbar vertebrae. There appears to be some sclerosis around the anterior focus but no evidence of new bone formation.

PATHOLOGY

Two specimens have been mounted. The right hand half of the spine as a tissue specimen, the left hand half as a macerated bony specimen. The 2nd, 3rd, 4th and 5th lumbar vertebrae are mounted. The second is healthy. The third contains two clusters of tuberculous foci which show in the dry bone as small hollows. The fourth and fifth bodies and the intervening disc are involved in a massive area of caseous tuberculous above which are two satellite foci. The disc has been destroyed and the vertebrae have fallen together. On the back of the specimen, opposite the lesion, is a small focus of caseous tissue in the upper part of the psoas muscle. The dry specimen shows the extent of the bony destruction and corresponds with the x-ray shadow.