Tuberculous spondylodiscitis with atypical presentation: A diagnostic challenge: Case report and review of literature

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.