Multifocal skeletal tuberculosis: Experience in diagnosis and treatment

Objectives. - 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. Patients and methods. - 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. Result. - Multiple antituberculous drugs, with supportive and immune-enhancing therapies cured the patient. Conclusions. - 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. (C) 2009 Elsevier Masson SAS. All rights reserved.