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Multifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case report

BACKGROUND: The occurrence of non-contiguous, multiple, and remote involvement tuberculous spondylitis is rare. The clinical presentation in patients with multifocal musculoskeletal tuberculosis may closely mimic that in patients with multiple bone metastases, which makes the accurate clinical diagn...

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Autores principales: Ye, Meiping, Huang, Jinwei, Wang, Jie, Ren, Jianmin, Tu, Jianfei, You, Weibo, Zhu, Taohui
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4731994/
https://www.ncbi.nlm.nih.gov/pubmed/26823075
http://dx.doi.org/10.1186/s12879-016-1376-7
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author Ye, Meiping
Huang, Jinwei
Wang, Jie
Ren, Jianmin
Tu, Jianfei
You, Weibo
Zhu, Taohui
author_facet Ye, Meiping
Huang, Jinwei
Wang, Jie
Ren, Jianmin
Tu, Jianfei
You, Weibo
Zhu, Taohui
author_sort Ye, Meiping
collection PubMed
description BACKGROUND: The occurrence of non-contiguous, multiple, and remote involvement tuberculous spondylitis is rare. The clinical presentation in patients with multifocal musculoskeletal tuberculosis may closely mimic that in patients with multiple bone metastases, which makes the accurate clinical diagnosis challenging. Herein, we report a multifocal musculoskeletal tuberculosis case that was misdiagnosed for 8 months as multiple bone metastases. CASE PRESENTATION: A 63-year-old male farmer of Chinese Han ethnicity presented to us with pain in left side of the neck, right side of the chest and the back for 10 months without typical tuberculosis symptoms. His past medical history, the CT and fluoroscopy-guided biopsy were negative for tuberculosis. Interferon gamma by T-SPOT was also negative. Radiological findings including CT, MRI and PET-CT suggested that the patient had multiple metastases. Accordingly, the patient was misdiagnosed as having musculoskeletal tumors until a swelling under the right nipple ulcerated. The smear test for acid-fast bacilli and the PCR test for TB-DNA of the pus from the swollen area were both positive, leading to the final correct diagnosis of musculoskeletal tuberculosis. CONCLUSION: The proper diagnosis of musculoskeletal tuberculosis is clinically challenging due to Mycobacterium tuberculosis variants involved and atypical presentations, especially when the lesions are multiple. Our findings indicate that multiple tuberculous spondylitis must be considered in the differential diagnosis of multiple musculoskeletal lesions.
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spelling pubmed-47319942016-01-30 Multifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case report Ye, Meiping Huang, Jinwei Wang, Jie Ren, Jianmin Tu, Jianfei You, Weibo Zhu, Taohui BMC Infect Dis Case Report BACKGROUND: The occurrence of non-contiguous, multiple, and remote involvement tuberculous spondylitis is rare. The clinical presentation in patients with multifocal musculoskeletal tuberculosis may closely mimic that in patients with multiple bone metastases, which makes the accurate clinical diagnosis challenging. Herein, we report a multifocal musculoskeletal tuberculosis case that was misdiagnosed for 8 months as multiple bone metastases. CASE PRESENTATION: A 63-year-old male farmer of Chinese Han ethnicity presented to us with pain in left side of the neck, right side of the chest and the back for 10 months without typical tuberculosis symptoms. His past medical history, the CT and fluoroscopy-guided biopsy were negative for tuberculosis. Interferon gamma by T-SPOT was also negative. Radiological findings including CT, MRI and PET-CT suggested that the patient had multiple metastases. Accordingly, the patient was misdiagnosed as having musculoskeletal tumors until a swelling under the right nipple ulcerated. The smear test for acid-fast bacilli and the PCR test for TB-DNA of the pus from the swollen area were both positive, leading to the final correct diagnosis of musculoskeletal tuberculosis. CONCLUSION: The proper diagnosis of musculoskeletal tuberculosis is clinically challenging due to Mycobacterium tuberculosis variants involved and atypical presentations, especially when the lesions are multiple. Our findings indicate that multiple tuberculous spondylitis must be considered in the differential diagnosis of multiple musculoskeletal lesions. BioMed Central 2016-01-29 /pmc/articles/PMC4731994/ /pubmed/26823075 http://dx.doi.org/10.1186/s12879-016-1376-7 Text en © Ye et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Ye, Meiping
Huang, Jinwei
Wang, Jie
Ren, Jianmin
Tu, Jianfei
You, Weibo
Zhu, Taohui
Multifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case report
title Multifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case report
title_full Multifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case report
title_fullStr Multifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case report
title_full_unstemmed Multifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case report
title_short Multifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case report
title_sort multifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4731994/
https://www.ncbi.nlm.nih.gov/pubmed/26823075
http://dx.doi.org/10.1186/s12879-016-1376-7
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