Multifocal musculoskeletal tuberculosis in an immunocompetent Iraqi patient

Abstract

Abstract: Musculoskeletal tuberculosis (TB) is an ancient disease; features of spinal TB have been identified in Egyptian mummies dating back 9000 years. It accounts for 10%–35% of cases of extrapulmonary TB. The occurrence of noncontiguous, multifocal musculoskeletal TB in immunocompetent persons is rare even in countries which are endemic in TB. Here, we present a case of multifocal musculoskeletal TB involving multiple levels of the spine and a peripheral joint. A 25-year-old female from Baghdad presented to us with inflammatory back pain for 9 months. She had a negative medical history. Initially, she was treated as a case of pyogenic discitis based on her magnetic resonance imaging results and high inflammatory markers; she was given antibiotics without clinical improvement. Later on, she developed pleural effusion with new painful swelling in her left ankle joint. Aspiration of the left ankle joint was performed, and a biopsy was taken and sent for a TB-DNA polymerase chain reaction test, which was positive, leading to the final diagnosis of musculoskeletal TB. The correct diagnosis of musculoskeletal TB is clinically challenging and difficult, especially when there are multilevel lesions. Our findings indicate that multiple tuberculous lesions must be considered in the differential diagnosis of multiple musculoskeletal lesions, especially in endemic areas such as Iraq.