A homeless man presents with back pain and vertebral body destruction. Which condition is most likely?

The presentation of back pain accompanied by vertebral body destruction in a homeless individual is highly suggestive of an infection, particularly tuberculosis. Tuberculosis of the spine, also known as Pott’s disease, often presents with the destruction of vertebral bodies due to the infection spreading from the lungs to the vertebrae. In homeless populations, there is a higher prevalence of conditions such as tuberculosis due to factors like poor living conditions and lack of access to healthcare.

The symptoms of back pain and vertebral destruction are characteristic of spinal tuberculosis, as the bacteria can form abscesses and lead to significant structural damage. This aligns well with the demographic and clinical details provided in the scenario.

While other conditions listed, such as hyperparathyroidism, multiple myeloma, and osteitis deformans, can cause bone lesions or back pain, they are less likely given the context. Hyperparathyroidism could lead to bone changes but typically does not present predominantly with vertebral body destruction. Multiple myeloma can cause vertebral destruction, but it usually presents with additional laboratory findings, such as abnormal protein levels, and typically occurs in older adults rather than a homeless individual. Osteitis deformans (Paget’s disease) involves disorganized bone remodeling and would be