1 - Radiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Neuroradiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
3 - Radiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
4 - Neuroradiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- Publicação em versão integral
- Case of the month, AJNR (American Journal of Neuroradiology) (Setembro 2021)
Resumo:
Introduction: Tuberculosis incidence is increasing. Skeletal tuberculosis accounts for 10-20% of all extra-pulmonary cases, and the spine is involved in up to 50% of these. Active pulmonary disease is present in less than 50% of skeletal tuberculosis cases.
Case Report: A 17-year-old girl presented with 1-year long complaints of dorsal and lumbosacral pain, with increased intensity in the past three months and poor response to various pain medication, associated with diminished upper limb strength. She underwent dorso-lumbar CT which showed multiple lytic lesions. She had no history of fever or weight loss. Physical examination was unremarkable. Blood analysis showed a PCR of 7,35mg/dl. She had a moderately increased ADA 19, with normal IGRA. An occult primary tumor was suspected, so she performed a thoraco-abdominal-pelvic CT with no further findings besides the skeletal lytic lesions which were further characterized by spinal MRI (where lymphoproliferative disorders or a granulomatous disease were suggested as differential diagnosis). CT-guided biopsy of one of the lesions (paravertebral soft-tissue mass) was compatible with tuberculosis. A positive epidemiological history was further assessed (contact with a colleague with tuberculosis 1 year before in-hospital admission) and had completed tuberculosis treatment for less than one month after the contact.
Conclusion: In this case. the chronic clinical picture and epidemiological contact was critical to the diagnosis. MRI detects spine TB early changes and is the modality of choice for determining the extent of soft tissue involvement. An infiltrative pattern of TB osteomyelitis may be seen with a pattern resembling Ewing’s sarcoma, fungal infection, chronic pyogenic osteomyelitis and lymphoproliferative disorders like in lymphomas.
Palavras Chave: Coluna, Radiologia, RM, TC, Tuberculose