A 28-year-old man presents with acute onset back pain, high-grade fever, and severe tenderness over the L3-L4 spine. MRI shows L3-L4 disc space narrowing with end-plate destruction and a small epidural abscess. Blood cultures grow Staphylococcus aureus. Which feature most strongly favors pyogenic over tuberculous spondylitis?

• A Involvement of the vertebral body
• B Presence of epidural abscess
• C Acute onset with high-grade fever and severe tenderness ✓
• D Disc space narrowing

Explanation

Pyogenic spondylitis presents acutely with high-grade fever, severe localized tenderness, and leukocytosis. Tuberculous spondylitis has an insidious onset with low-grade fever and minimal tenderness. Both can involve the vertebral body, cause disc space narrowing, and form epidural abscesses. The acute presentation with positive blood cultures is the key discriminator.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.