Skipped multilevel lesion as an atypical tuberculous spondylitis mimicking spinal metastasis: A case report

Abstract

Tuberculosis (TB) is one of major global health threats and leads to morbidity and mortality. TB is prevalent in low and middle income countries especially in Sub-Saharan Africa and South East Asia. M. tuberculosis usually affects the lungs. Spine is the most common extrapulmonary sites for TB after lymph nodes, accounts for 1% of all TB cases, and 50 to 60% of osteoarticular TB. In the case of spinal TB, two or more adjacent vertebrae are usually involved due to hematogenous spread of bacteria in which the vertebral arteries feed the two adjacent vertebrae. The incidence of multiplelevel non-contiguous spinal TB is 1.1 to 16% of all skeletal TB. Multiple-level non-contiguous, an atypical form of spinal TB is rare. It has insidious symptoms, often with diagnostic delays and a higher risk of permanent neurological deficits. We report a case of atypical TB spondylitis with non-contiguous multiple level of lesions mimicking multiple bone metastases.

Non‐contiguous multilevel spinal tuberculosis: A case report of unusual spinal tuberculosis resembling spinal metastasis

“…The unique aspect of our case is the combination of NMLST with posterior lesions, preserved intervertebral discs, and soft‐tissue components in paraspinal and cord compression, which resemble pyogenic spondylitis and spinal malignancy 20 . Pyogenic vertebral osteomyelitis and spondylodiscitis are commonly caused by Staphylococcus aureus 21 .…”

“…The unique aspect of our case is the combination of NMLST with posterior lesions, preserved intervertebral discs, and soft-tissue components in paraspinal and cord compression, which resemble pyogenic spondylitis and spinal malignancy. 20 Pyogenic vertebral osteomyelitis and spondylodiscitis are commonly caused by Staphylococcus aureus. 21 Potential risk factors are intravenous drug abuse, diabetes, recent systemic infection, immunosuppression, or malignancy, while TB as a causative agent is often seen in immunocompromised patients or endemic areas with low socioeconomic status.…”

Complete resolution of otogenic cerebellar abscess with conservative approach: Two case reports

“…Brain scans should be performed for all patients with suspected brain abscess. CT head scans with contrast provide a quick way to detect abscess size, number, and localization [ 2 , 10 ].…”

“…Broad-spectrum antibiotics that can cross the blood–brain barrier and blood–cerebrospinal fluid barrier in sufficient concentrations should be used as the first line of treatment. Empirical antibiotics should include coverage for anaerobic organism, such as third-generation cephalosporins and metronidazole, as well as vancomycin if the patient has a history of penetrating trauma or recent neurosurgical procedures [ 3 , 10 ]. In patients with bacterial brain abscess, intravenous antibiotic therapy has traditionally lasted six to eight weeks.…”

Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions

“…Drug chemotherapy + Surgery Better Abboud et al 27 40/None stated Back pain C7-T4, T10-L1 Drug chemotherapy + Surgery Better Kulali et al 28 16/M Paraplegia T6, T10 Drug chemotherapy + Surgery Better Gao et al 29 48/F Back pain T7, L4 None stated None stated Yuen et al 30 28/M Back pain T5, T7-T11, L1, L4-S5 Drug chemotherapy + Surgery Better Kim et al 31 27/M Back pain T9-T11, S2 Drug chemotherapy Better Ye et al 32 63/M Neck, chest, back and left upper limb pain, Hypesthesia C4-C6, T10, T11 Drug chemotherapy Better Sharma et al 33 12/F Back pain T1, T8-T10, L3, L4 Drug chemotherapy Better Sugianto et al 34 20/F Back pain, Paraplegia T2-T4, L2-L4 Drug chemotherapy + Surgery Better Prajapati et al 35 18/F Back pain C2, C4, T3, T9, T11, L1, L3, L5, S2 38 14/M Back pain T5, T6, T11, T12, L3, L4 Drug chemotherapy Better Neher et al 39 23/M Back pain T4-T6, T9, T10, T12-L2, L4-S2…”