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Back pain and oedematous Schmorl node: a diagnostic dilemma
  1. Aakriti Pandita1,
  2. Nikhil Madhuripan2,
  3. Rocio M Hurtado3,
  4. Amit Dhamoon1
  1. 1Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
  2. 2Radiology, Baystate State Health System, Springfield, Massachusetts, USA
  3. 3Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Amit Dhamoon, dhamoona{at}


A 26-year-old female from India presented with progressive, unremitting low back pain for over 1 year. She had been treated unsuccessfully for left-sided sacroiliitis, pelvic floor dysfunction, ankylosing spondylitis and seronegative spondyloarthritis. MRI lumbar spine showed a Schmorl node with surrounding marrow oedema at L4, the relevance of which is not clear in literature. One year after initial presentation, a biopsy of this lesion revealed culture positive diagnosis of spinal tuberculosis. Despite advances in imaging, delayed diagnosis is not uncommon in spinal tuberculosis (TB). In our case, it was also attributed to an unknown early lesion: Schmorl node with surrounding oedema. Any association of this lesion with spinal TB has previously not been reported.

  • Infections
  • Bone and joint infections
  • TB and other respiratory infections

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  • Contributors AP wrote and edited the manuscript. NM compiled the imaging studies and provided editorial feedback on the manuscript content. RMH edited and provided feedback on the infectious disease content of the manuscript. AD edited and provided feedback on the content of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.