Rare Case of Spinal Tuberculosis Mimicking Disseminated Malignant Disease in a 9-Year-Old Boy

Abstract

Purpose

Musculoskeletal tuberculosis in children is a rare disease that most commonly affects the spine. Young children living in areas with high disease prevalence are at increased risk of developing tuberculosis. With this case report, we aim to emphasize the high degree of suspicion one must have in diagnosing pathological fracture of vertebrae including disseminated malignant disease and multiple tuberculous spondylitis lesions in differential diagnosis.

Methods

We retrospectively examined our patient’s hospital record including clinical presentations, diagnostic tools, management, and outcomes. Magnetic resonance imaging is the method of choice for diagnosing infectious discitis and spondylodiscitis. However, the etiological agent can be distinguished only by needle aspiration or bone biopsy.

Results

In the presented case, the initial symptoms of spinal tuberculosis that included back pain, neck pain with torticollis and, to a large extent, MRI findings, raised our suspicion of disseminated malignant disease. Skin abscess aspiration and bone biopsy confirmed extrapulmonary tuberculosis, while pulmonary tuberculosis was unlikely. With the increased inflow of Bacillus Calmette-Guerin–vaccinated immigrants and refugees from high-burden tuberculosis countries, the interferon gamma release assay is preferred over the tuberculin skin test to screen for latent tuberculosis infection.

Discussion

Early diagnosis and treatment of spinal tuberculosis are necessary to prevent neurological disability and kyphosis. The presentation of spinal tuberculosis with atlanto-axial subluxation and compression fractures of vertebrae is unusual. The large extent of spinal tuberculosis changes on imaging does not always correlate with reported signs and symptoms. Nevertheless, children with spinal tuberculosis should be followed up until skeletal maturity.