Skeletal Tuberculosis

Journal of General Internal Medicine, Feb 2017

Saate Shakil, Elliot Dickerson, Rabih Geha

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Skeletal Tuberculosis

J Gen Intern Med Clinical Images Skeletal Tuberculosis Saate Shakil 1 2 Elliot Dickerson 0 Rabih Geha 2 0 Department of Radiology, University of California , San Francisco, CA , USA 1 , San Francisco, CA , USA 2 Department of Medicine, University of California , San Francisco, CA , USA - A 43-year-old man from the Philippines presented with lumbar pain and right lower extremity weakness. He was diagnosed with sciatica. Worsening pain, weight loss and elevated inflammatory markers prompted MRI of the spine, which showed multi-level spinal lesions. Bone biopsy showed granulomatous osteomyelitis. Sputum and bone acid-fast stains were negative. However, bone cultures subsequently grew Mycobacterium tuberculosis (M.Tb). His symptoms failed to improve despite standard M.Tb treatment. MRI of the spine revealed multilevel infiltrative rim-enhancing lesions with sparing of the intervertebral discs and large areas of extra-vertebral extension (Fig. 1). Culture sensitivities revealed multidrugresistant tuberculosis, and antibiotics were adjusted. He underwent debulking surgery, with subsequent resolution of symptoms. Skeletal tuberculosis (Pott’s disease) accounts for 10% of extrapulmonary tuberculosis.1 The thoracic spine is most frequently affected.1 Patients commonly present with progressive pain, focal neurologic signs, and constitutional symptoms.2 On imaging, the relative sparing of the intervertebral disc, attributed to the absence of proteolytic enzymes in mycobacteria, and the presence of extensive soft tissue involvement distinguish Pott’s disease from other infectious or malignant diseases of the spine.3,4 Inherited or acquired immunodeficiency syndromes (e.g. HIV) should be considered; however, as with our patient, Pott’s disease may occur in immunocompetent patients.1 Compliance with Ethical Standards: Conflict of Interest: The authors declare that they do not have a conflict of interest. 1. McLain RF , Isada C . Spinal tuberculosis deserves a place on the radar screen . Cleve Clin J Med . 2004 ; 71 ( 7 ): 537 - 9 . 2. Sunrise FL , Beachwood OH , Weston FL , Calendar MC . Persistent back pain in a young woman . Cleve Clin J Med . 2015 ; 82 ( 6 ): 337 - 8 . 3. Bell GR , Stearns KL , Bonutti PM , Boumphrey FR . MRI diagnosis of tuberculous vertebral osteomyelitis . Spine . 1990 ; 15 ( 6 ): 462 - 5 . 4. Chapman M , Murray RO , Stoker DJ . Tuberculosis of the bones and joints . Semin Roentgenol . 1979 ; 14 : 266 - 82 .

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Saate Shakil, Elliot Dickerson, Rabih Geha. Skeletal Tuberculosis, Journal of General Internal Medicine, 2017, 846-847, DOI: 10.1007/s11606-017-4001-6