Ghoullam Ghizlane, El Binoune Imane, Rostom Samira, Zemrani Salma, El Moubarik Ikram, Amine Bouchra, Bahiri Rachid
Rheumatology Department A, El Ayachi Hospital, Ibn Sina University Hospital, Salé 11000, Morocco.
Radiol Case Rep. 2025 Aug 30;20(11):5762-5768. doi: 10.1016/j.radcr.2025.08.005. eCollection 2025 Nov.
Spinal tuberculosis is the most common form of osteoarticular tuberculosis and presents significant diagnostic challenges, especially in atypical cases. It may clinically and radiologically mimic neoplastic lesions, particularly when disc involvement is absent. We report a case of a 60-year-old woman with a history of treated lymph node tuberculosis who presented with chronic inflammatory dorsolumbar pain without systemic symptoms. Initial imaging revealed lytic lesions of the D11-D12 vertebrae with preservation of the intervertebral disc, raising suspicion of a neoplastic process. A PET scan demonstrated hypermetabolism at the affected level, and a first biopsy showed nonspecific inflammatory lesions. The patient was lost to follow-up but was later readmitted with worsening symptoms. Further investigations revealed vertebral lysis on radiographs and D11-D12 spondylodiscitis with a right psoas abscess on MRI. CT imaging showed lymphadenopathy, disc-vertebral involvement, and a psoas collection, more suggestive of tuberculosis than malignancy. A second biopsy confirmed granulomatous inflammation, establishing the diagnosis of a tuberculous spondylodiscitis. The patient was successfully treated with a 9-month anti-tuberculous regimen, resulting in significant clinical and radiological improvement. Tuberculous spondylodiscitis should be considered in the differential diagnosis of isolated spinal lesions suggestive of malignancy, especially in endemic regions. Early diagnosis and appropriate treatment are crucial to prevent complications.
脊柱结核是骨关节结核最常见的形式，带来了重大的诊断挑战，尤其是在非典型病例中。它在临床和影像学上可能酷似肿瘤性病变，特别是在没有椎间盘受累的情况下。我们报告一例60岁女性，有淋巴结结核治疗史，表现为慢性炎性腰背痛，无全身症状。初始影像学检查显示第11 - 12胸椎椎体溶骨性病变，椎间盘未受累，怀疑为肿瘤性病变。PET扫描显示病变部位代谢增高，首次活检显示非特异性炎性病变。该患者失访，但后来因症状加重再次入院。进一步检查显示X线片上有椎体骨质溶解，MRI显示第11 - 12胸椎椎体椎间盘炎伴右侧腰大肌脓肿。CT成像显示淋巴结肿大、椎间盘 - 椎体受累及腰大肌积液，更提示为结核而非恶性肿瘤。第二次活检证实为肉芽肿性炎症，确诊为结核性椎体椎间盘炎。该患者接受了为期9个月的抗结核治疗方案，临床和影像学均有显著改善。在鉴别诊断提示为恶性肿瘤的孤立性脊柱病变时，应考虑结核性椎体椎间盘炎，特别是在流行地区。早期诊断和恰当治疗对于预防并发症至关重要。
