Spinal Manifestations of Tuberculosis

A 32-year-old Sudanese national presented to the emergency department complaining of back pain for the past 4 months. He had new-onset fever of 1 day`s duration. A CT stone protocol was ordered, which showed lytic lesions with extraosseous fullness in the 7th right rib and 8th left rib, and the T8-T10 and L4 vertebrae, the latter involving the left psoas major muscle. There was a lytic lesion in the body of the left iliac bone as well. Contrast-enhanced total-body CT showed the extraosseous extension of disease to be abscesses and also showed necrotic mediastinal lymph nodes. MRI spine depicted the abscesses in exquisite detail. Biopsies were obtained from a costal lesion and from the iliac lesion, which yielded M. tuberculosis. Interestingly, the lungs were clear.