Department of Infectious Diseases, The Third Affiliated Hospital to Wenzhou Medical College, Rui'an, Zhejiang, 108, Wan song Road, Rui'an, 325200 Zhejiang, China.
Med Mal Infect. 2010 Jan;40(1):6-11. doi: 10.1016/j.medmal.2009.03.004. Epub 2009 Apr 8.
Multifocal skeletal tuberculosis (MSTB) is an uncommon presentation of skeletal tuberculosis. In order to provide more clinically meaningful information on the diagnosis and management of MSTB, we present a case of MSTB with multiple tuberculous lesions in multiple locations, along with a review of 13 MSTB cases from different studies.
A 29-year-old male patient with a one-year history of back pain was initially diagnosed with ankylosing spondylitis and arthritis deformans, and received treatment with oral glucocorticosteroid and leflunomide for 24 weeks. The back pain worsened with weight loss and fever one month prior to admission to our hospital. The diagnosis, MSTB, with 26 tuberculous lesions in 19 locations, was made by clinical findings, bone scan (computed topography and Tc-99m HDP scintigraphy), and bone marrow smear.
Multiple antituberculous drugs, with supportive and immune-enhancing therapies cured the patient.
This case indicates that MSTB may develop in patients on long-term immunosuppressive drugs. In addition, our experience, along with previously reported data, suggest that strong clinical suspicion is required for an early diagnosis of MSTB, and chemotherapy, combined with supportive and immune-based therapies is effective for the treatment of MSTB.
多灶性骨骼结核病（MSTB）是骨骼结核病的一种罕见表现。为了提供更多关于 MSTB 的诊断和管理的临床意义信息，我们报告了一例多灶性骨骼结核病，该患者有多个部位的多个结核病变，并回顾了来自不同研究的 13 例 MSTB 病例。
一名 29 岁男性患者，背痛病史一年，最初被诊断为强直性脊柱炎和关节炎变形，并接受了口服糖皮质激素和来氟米特治疗 24 周。在入院前一个月，因体重减轻和发热，背痛加重。通过临床发现、骨扫描（计算机断层扫描和 Tc-99m HDP 闪烁扫描）和骨髓涂片，诊断为 MSTB，19 个部位有 26 个结核病变。
多种抗结核药物联合支持和免疫增强治疗治愈了患者。
本病例表明，长期接受免疫抑制药物治疗的患者可能会发生 MSTB。此外，我们的经验以及以前报告的数据表明，需要高度怀疑 MSTB 以进行早期诊断，并且化疗联合支持和免疫治疗对 MSTB 的治疗有效。
