Abstract
IntroductionOsseous tuberculosis can be present with unifocal or multifocal bony involvement. Although multifocal involvement of the skeletal system in areas where tuberculosis is endemic is not a rare presentation, its exact prevalence is not well known. A case of atypical skeletal tuberculosis mimicking multiple secondary metastases on radiologic and scintigraphic imaging is presented to emphasize the contribution of bone scintigraphy in the assessment of osseous tuberculosis in typical and atypical presentations.Case presentationA 73-year-old cachectic Asian man (Iranian) presented with a general feeling of being unwell and an acute loss of vision in his left eye accompanied by a severe headache. A Tc-99 m-methylene diphosphonate bone scan demonstrated multiple regions of intense activity in the appendicular and axial skeleton, suggesting metastatic involvement. Tumor markers (PSA, CA125, CA 19-9 and AFP) were within normal ranges. Based on clinical presentation and laboratory, radiological and scintigraphic findings, a presumptive diagnosis of tuberculosis was made. Quadruple antituberculous chemotherapy was consequently started and the patient later showed marked improvement.ConclusionScintigraphic bone scanning should be kept in mind when assessing bone pain in patients at a high risk of tuberculosis infection or reactivation. We present this unusual case of multifocal skeletal tuberculosis, and stress the related clinical and diagnostic points with the aim of stimulating a high index of suspicion that could facilitate early diagnosis and appropriate treatment.
Highlights
Osseous tuberculosis can be present with unifocal or multifocal bony involvement
A case of atypical skeletal TB mimicking multiple secondary metastases on radiologic and scintigraphic imaging is presented to emphasize the contribution of bone scintigraphy in the assessment of osseous TB in typical and atypical presentations
TB is a mycobacterial infection leading to morbidity and mortality of patients in many different regions of world
Summary
In areas where TB is endemic, multifocal skeletal TB is not rare; in analysing a bone scan that shows multiple lesions, multifocal skeletal TB should be considered in the differential diagnosis especially when the origin of the disease is unknown. A skeletal scintigraphy can show the extent and distribution of osseous lesions in cases of suspected skeletal TB. In the early stages, when radiological imaging such X-ray, MRI or CT is normal, a whole body bone scan may help detect lesions and provide a site for biopsy diagnosis. CT: computed tomography; MRI: magnetic resonance imaging; TB: tuberculosis. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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