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Multifocal tuberculous osteomyelitis mimicking widespread bony metastases: review of literature and case report

Subjects

Abstract

Introduction

Mycobacterium tuberculosis infections remain a significant cause of morbidity and mortality worldwide. Extrapulmonary infections are less common, and skeletal tuberculosis accounts for about 5–20% of all cases. Skeletal tuberculosis cases often pose diagnostic challenges due to its insidious onset, non-specific clinical presentation and radiographic findings similar to other diseases. Multifocal skeletal tuberculosis is an extremely rare clinical entity, and is defined as an infection that affects two or more non-contiguous bony structures. This clinical entity can mimic bony metastasis and may lead to delays in diagnosis and treatment.

Case presentation

We present a case of multifocal skeletal tuberculous infection mimicking widespread bony metastasis, occurring in an immunocompetent 28-year-old male, and discuss the diagnostic challenges faced and management strategies. The patient successfully underwent instrumentation and stabilization of a pathological T11 vertebra fracture and treatment of tuberculosis infection.

Discussion

While TB infections remain less common in developed countries, they can still cause significant morbidity. Multifocal skeletal tuberculous infections can resemble spinal or bony metastasis on various imaging modalities. Care must be taken when interpreting such imaging results, with histopathology and mycobacterial cultures remaining the gold standard to determine the presence of active TB infections.

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Fig. 1: Initial anteroposterior (AP) and lateral plain radiographs of the thoracolumbar spine.
Fig. 2: MRI imaging of the thoracic spine.
Fig. 3: MRI imaging of the thoracic and lumbosacral spine.
Fig. 4: Bone scintigraphy (Tc-99m MDP) scan.
Fig. 5: CT thorax done pre-operatively.
Fig. 6: Histopathological slides taken from the CT-guided sacrum biopsy.
Fig. 7: AFB culture report taken from the CT-guided sacrum biopsy.
Fig. 8: AP and lateral plain radiographs of the thoracic spine taken on follow-up review.

Data availability

All data generated or analyzed during this study are included in this published article (and its supplementary information files).

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All authors contributed equally to this work and were involved with the literature review, cases analysis and manuscript writing.

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Correspondence to Wen Loong Paul Yuen.

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The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

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Yuen, W.L.P., Loo, W.L. Multifocal tuberculous osteomyelitis mimicking widespread bony metastases: review of literature and case report. Spinal Cord Ser Cases 8, 23 (2022). https://doi.org/10.1038/s41394-022-00496-9

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