Dorso-Lumbar Wall Abscess Associated with Sacroiliitis: Exceptional Localizations of Tuberculosis

Abstract

Introduction: Tuberculosis of the abdominal wall is a rare localization, the diagnosis of which on imaging remains difficult due to the absence of specific radiological signs, despite advances in imaging. Objective: The aim of this work is to reveal the interest of imaging in the diagnosis of this pathology. Case Report: We report the case of a 42- year-old man, with no history of tuberculosis infection, who presented for 4 months with a painless right dorsolumbar tumefaction, without fever, progressively increasing in volume, with the appearance of low back pain and uncounted weight loss 2 months later. Ultrasound examination of the swelling revealed two parietal collections, measuring respectively 1.2x3.5 cm and 4.8x3cm in long axis, with thickened walls communicating with each other through a pertus; they had a heterogeneous hypoechoic echostructure, containing fine non-vascularized echoes on color Doppler. A complementary CT scan) showed heterogeneously dense collections opposite L4 and L5, merging in depth, associated with a right sacroiliitis consisting of a significant widening of the joint space, erosions and subchondral geodes of the sacral joint side, with bone sequestration.The lesion assessment revealed another cerebral localization in the form of a left parietal tuberculoma. Percutaneous puncture of the parietal collection with culture on Löwenstein-Jensen medium revealed tubercle bacilli. Conclusion: Isolated parietal localization is a rare and unrecognized form of tuberculosis. Imaging can distinguish a tuberculous cold abscess from a wall tumor. Only histological and/or bacteriological examination of biopsies of the mass can confirm the diagnosis.