title: Causes of misdiagnosis and mistreatment of spinal tuberculosis with radiotherapy in nonendemic areas: a pitfall in diagnosis and treatment: hazards of radiotherapy on the tuberculous lesion.
abstract: METHODS
  Report of initially misdiagnosed and mistreated cases.
  
  
  OBJECTIVE
  To report a previously undescribed misdiagnosis and subsequent mistreatment with radiation for tuberculosis of the spine and to promote awareness for tuberculosis in nonendemic areas.
  
  
  BACKGROUND
  It is not seldom that radiation therapy is provided for suspected malignant spinal lesions without histologic confirmation. Literature is not available on harmful effects of radiation therapy for tuberculosis of the spine.
  
  
  METHODS
  Clinical case analysis for initial misdiagnosis and mistreatment, analysis of subsequent clinical course.
  
  
  RESULTS
  Two patients received radiotherapy on spinal lesions of suspected malignant origin. In both patients, the lesions were of tuberculous origin and the lesions increased during radiotherapy. In Case 2, the paraplegia did not heal.
  
  
  CONCLUSIONS
  In cases of a spinal lesion of unknown origin, tuberculosis should always be considered. Adequate biopsy for cultures and histology is mandatory. Radiotherapy locally aggravates tuberculous spinal lesions.
authors.affiliation: Department of Orthopaedic Surgery, Groningen University Medical Centre, Groningen, The Netherlands. p.c.jutte@orth.ucmg.nl
authors.forename: Paul C
authors.initials: PC
authors.lastname: Jutte
authors.forename: Richard
authors.initials: R
authors.lastname: van Altena
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Pras
authors.forename: Cees J P
authors.initials: CJ
authors.lastname: Thijn
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D019353:Endemic Diseases; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology*; D011832:Radiation Injuries; D011878:Radiotherapy / Q000009:adverse effects*; D023981:Sarcoma, Myeloid / Q000175:diagnosis; D013125:Spinal Neoplasms / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D014399:Tuberculosis, Spinal / Q000175:diagnosis* / Q000532:radiotherapy*