A Wolf in Disguise: Tuberculous Spondylitis Masquerading as Modic Changes With Reactivation After Epidural Steroid Injection - A Case Report.

Abstract

Background: Epidural steroid injections (ESIs) are commonly used for chronic low back pain but can rarely lead to serious infectious complications. Reactivation of latent tuberculous spondylodiscitis after ESI is uncommon. Our case highlights diagnostic challenges of underlying spinal infection prior to interventional pain procedures.

Case report: A 43-year-old woman presented with low back and radicular pain. There were no constitutional symptoms, and baseline laboratory findings were unremarkable. Lumbar magnetic resonance imaging (MRI) showed Modic-type degenerative changes and nerve root compression. A transforaminal ESI was performed for presumed lumbar radiculopathy, but the pain persisted. Three weeks later, contrast-enhanced MRI revealed findings consistent with spondylodiscitis. Computed tomography-guided biopsy confirmed tuberculous spondylodiscitis, and antituberculosis therapy was initiated, leading to clinical improvement before any complications developed.

Conclusions: Spinal tuberculosis may masquerade as degenerative Modic changes and may become clinically apparent following ESI. Persistent or worsening pain after spinal intervention should prompt reconsideration of the diagnosis.