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

Dae Geun Kim; Jae Hwan Cho; Jae Hyoun Kim; Jung-Ki Ha; Dong-Ho Lee; Choon Sung Lee

doi:10.4184/jkss.2015.22.2.55

Journal List > J Korean Soc Spine Surg > v.22(2) > 1076077

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Kim, Cho, Kim, Ha, Lee, and Lee: Thoracic Vertebral Fracture due to Spinal Tuberculosis which was Misdiagnosed as Matastatic Cancer - A Case Report -

Case Report

Journal of Korean Spine Surg 2015;22(2):55-59.

Published online: 21 June 2015

DOI: https://doi.org/10.4184/jkss.2015.22.2.55

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

Dae Geun Kim, M.D., Jae Hwan Cho, M.D., Jae Hyoun Kim, M.D., Jung-Ki Ha, M.D., Dong-Ho Lee, M.D., Choon Sung Lee, M.D.

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Corresponding author: Jae Hwan Cho, M.D. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea TEL: +82-2-3010-3530, FAX: +82-2-488-7877 E-mail: doctork78@hanmail.net

Received 25 September 2014 Revised 13 November 2014 Accepted 19 May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Spine, Pathologic fracture, Neoplasm metastasis, Tuberculosis, Decompression

REFERENCES

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.

Fig. 1.

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

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.

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.

Fig. 4.

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

Fig. 5.

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

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