J Korean Soc Spine Surg.  2015 Jun;22(2):55-59. 10.4184/jkss.2015.22.2.55.

Thoracic Vertebral Fracture due to Spinal Tuberculosis which was Misdiagnosed as Matastatic Cancer: A Case Report

• Kim DG
• Cho JH
• Kim JH
• Ha JK
• Lee DH
• Lee CS

• KMID: 2322953
• DOI: http://doi.org/10.4184/jkss.2015.22.2.55

Abstract

STUDY DESIGN: A case report.
OBJECTIVES
To report the case of a patient whose preoperative imaging results seemed to show metastatic spine tumor but who actually had a vertebral pathologic fracture caused by spine tuberculosis. SUMMARY OF LITERATURE REVIEW: Tuberculosis spondylitis is classified into peridiscal, central, anterior, and posterior spondylitis according to the portion involved, and central spondylitis can be mistaken as a tumor.
MATERIALS AND METHODS
Imaging studies were performed in a 79-year-old female with progressive lower extremity weakness. We found a T12 pathologic vertebral fracture, which was suspected to be metastatic cancer.
RESULTS
We performed surgery and found spine tuberculosis in the pathological and immunological examinations. Two weeks postoperatively, the patient could walk with crutches and underwent anti-tuberculosis therapy.
CONCLUSIONS
Even when the results of imaging studies predict spinal metastasis, we should keep in mind the possibility of spinal tuberculosis.

Keyword

Spine; Pathologic fracture; Neoplasm metastasis; Tuberculosis; Decompression

MeSH Terms

Aged
Crutches
Decompression
Female
Fractures, Spontaneous
Humans
Lower Extremity
Neoplasm Metastasis
Spine
Spondylitis
Tuberculosis
Tuberculosis, Spinal*

Figure

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  Fig. 1. Anteroposterior and lateral X-rays of the T-L spine show a T12 compression fracture.

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  Fig. 2. (A) A low signal in the bone marrow of T11 and T12, as well as cord compression can be observed in the T1-weighted magnetic resonance imaging (MRI). (B) The T2-weighted MRI demonstrates a low signal in T12 with cord compression. (C) The gadolinium-enhanced MRI shows en-hancement of the T11, T12, and L1 vertebral bodies and T12 bilateral pedicle with epidural soft tissue formation and dural sac compression.

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  Fig. 3. The 18-FDG PET-CT results led to a suspicion of metastatic cancer due to a compression fracture in T12 with uneven hypermetabolic lesions in T11–L1.

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  Fig. 4. Postoperative simple X-ray shows T12 posterior decompression with vertebroplasty and posterolateral fusion in T9–L3.

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  Fig. 5. Photomicrograph from excisional biopsy shows chronic granuloma-tous inflammation (white arrow) with necrosis (black arrow) (hematoxylin– eosin stain, 200×).

Reference

1. Joint committee for the development of guidelines for tuberculosis, prevention Kcfdca: Korea guidelines for tuberculosis first edition. 2011.

2. Sankaran-Kutty M. Atypical tuberculous spondylitis. Int Orthop. 1992; 16:69–74.

3. Currie S, Galea-Soler S, Barron D, et al. MRI characteristics of tuberculous spondylitis. Clin Radiol. 2011; 66:778–87.

4. Ha KY, Na KT, Kee SR, et al. Tuberculosis of the Spine: A new Understanding of an Old Disease. J Korean Soc Spine Surg. 2014; 21:41–7.

5. Jahng J, Kim YH, Lee KS. Tuberculosis of the lower lumbar spine with an atypical radiological presentation - a case mimicking a malignancy. Asian Spine J. 2007; 1:102–5.

6. Jeon CH, Yoon JK, Cho JH, et al. Usefulness of Fluorine-18 FDG-PET in the Diagnosis of Vertebral Pathologic Fracture. J Korean Soc Spine Surg. 2006; 13:191–9.

7. Golden MP, Vikram HR. Extrapulmonary tuberculosis: an overview. Am Fam Physician. 2005; 72:1761–8.

8. Dosanjh DP, Hinks TS, Innes JA, et al. Improved diagnostic evaluation of suspected tuberculosis. Ann Intern Med. 2008; 148:325–36.

9. Pai M, Riley LW, Colford JM, et al. Interferon-gamma as-says in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis. 2004; 4:761–76.

10. Dewan PK, Grinsdale J, Kawamura LM. Low sensitivity of a whole-blood interferon-gamma release assay for detection of active tuberculosis. Clin Infect Dis. 2007; 44:69–73.