Diagnostic role of whole body bone scintigraphy in atypical skeletal tuberculosis resembling multiple metastases: a case report

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.

Multifocal bacterial osteomyelitis in a renal allograft recipient following urosepsis

“…A three phase technetium-99m methylene diphosphonate bone scan is both sensitive and specific (94% and 95% respectively) for the diagnosis of osteomyelitis in the absence of recent trauma or surgery. [ 14 ] Multifocal uptake on a bone scan is also seen with multifocal bone tumors (osteochondromas, osteosarcomas, histiocytosis X, fibrous dysplasia), bone lymphomas and bone metastasis;[ 15 ] however the history, examination findings and isolation of E. coli from repeated pus cultures, confirmed the diagnosis of multifocal osteomyelitis in this patient.…”

Tuberculous osteomyelitis of the mandible impersonating dentoalveolar abscess: a case report

“…As per the policy of WHO updated in 2013, the diagnosis of TB using CB-NAAT could possibly replace microscopy and can be used for diagnosis of all suspected PTB and EPTB cases [8]. Besides, a Te 99 m-methylene diphosphonate bone scan may be performed in cases where multifocal skeletal TB is suspected i.e., those complaining of bone pain [9].…”

Paciente VIH positivo con tuberculosis sistémica y lesiones osteolíticas de la calvaria, semejando mieloma múltiple

“…Posteriormente, al identificarse en el curso del tratamiento una prueba de sensibilidad MODS (11) , con resistencia a RFP, pero sensible a H/ET/PZ/S, se diagnosticó fracaso del esquema 1, por respuesta clínica inadecuada, debido a reinfección TBC. Al posibilitarse la expresión del curso natural de la TBC en inmunosuprimidos, se comprometió pulmón, ganglios linfáticos (10)(11)(12)(13)(14) , tejido subcutáneo del codo, parrilla costal y otros, diseminándose por vía hematógena a áreas de gran concentración de tejido hematopoyético, como hueso esponjoso, diploe craneal (10,(15)(16)(17) . Como las lesiones líticas craneales eran múltiples y con aspecto de sacabocado, fue obligatorio descartar mieloma múltiple (18) y otras neoplasias (19) .…”

“…Las metástasis cancerosas por linfomas no Hodgkin raramente comprometen vértebras o pedículos contiguos. En general, las metástasis casi siempre muestran espacios discales preservados, sin abscesos prevertebrales (16) . Ayudan al diagnóstico diferencial final la adecuada respuesta clínica del paciente a la terapia anti-MDR-TB y las características imagenológicas de las lesiones óseas.…”