Multicentric skeletal tuberculosis in the absence of pulmonary disease.

Abstract

A 19-year-old woman presented with a 2-month history of low back pain, night sweats, and weight loss. Examination revealed localized tenderness over the proximal lumbar spine. Her chest was clear and she had no lymphadenopathy. Spinal radiographs were normal and computed tomography (CT) demonstrated a lytic lesion in the spinous process of the L2 vertebra. CT-guided aspiration cytology yielded acid-fast bacilli, and a diagnosis of tuberculous (TB) spondylodiscitis was made. Subsequent investigations showed a raised erythrocyte sedimentation rate, but sputum tests for AFBs were negative and she was human immunodeficiency virus (HIV)-negative. She was treated with antituberculous drugs, including isoniazid (INH), rifampicin, pyrazinamide, and ethambutol for 3 months, and INH and rifampicin for another 9 months, and was then discharged symptom-free. Three years later, she was investigated for infertility. The laparoscopy examination revealed bilateral tubal occlusion presumed to be tuberculous. Her ovaries were normal. She was put on a further course of anti-TB treatment for the next year. She presented on a third occasion 3 months later with a second episode of back pain. A bone scan was done that demonstrated abnormal uptake in the thoracic spine, skull, pelvis, and long bones.