title: A fatal case of spinal tuberculosis mistaken for metastatic lung cancer: recalling ancient Pott's disease.
abstract: BACKGROUND
  Tuberculous spondylitis (Pott's disease) is an ancient human disease. Because it is rare in high-income, tuberculosis (TB) low incidence countries, misdiagnoses occur as sufficient clinical experience is lacking.
  
  
  METHODS
  We describe a fatal case of a patient with spinal TB, who was mistakenly irradiated for suspected metastatic lung cancer of the spine in the presence of a solitary pulmonary nodule of the left upper lobe. Subsequently, the patient progressed to central nervous system TB, and finally, disseminated TB before the accurate diagnosis was established. Isolation and antimycobacterial chemotherapy were initiated after an in-hospital course of approximately three months including numerous health care related contacts and procedures.
  
  
  CONCLUSIONS
  The rapid diagnosis of spinal TB demands a high index of suspicion and expertise regarding the appropriate diagnostic procedures. Due to the devastating consequences of a missed diagnosis, Mycobacterium tuberculosis should be considered early in every case of spondylitis, intraspinal or paravertebral abscess. The presence of certain alarm signals like a prolonged history of progressive back pain, constitutional symptoms or pulmonary nodules on a chest radiograph, particularly in the upper lobes, may guide the clinical suspicion.
authors.affiliation: Department of Medicine III, Pneumology, Allergology and Sleep Medicine, University Hospital Bergmannsheil, Ruhr-University Bochum, Germany. felix.ringshausen@web.de
authors.forename: Felix C
authors.initials: FC
authors.lastname: Ringshausen
authors.forename: Andrea
authors.initials: A
authors.lastname: Tannapfel
authors.forename: Volkmar
authors.initials: V
authors.lastname: Nicolas
authors.forename: Andreas
authors.initials: A
authors.lastname: Weber
authors.forename: Hans-Werner
authors.initials: HW
authors.lastname: Duchna
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schultze-Werninghaus
authors.forename: Gernot
authors.initials: G
authors.lastname: Rohde
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003951:Diagnostic Errors; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D009161:Mycobacterium / Q000302:isolation & purification; D009362:Neoplasm Metastasis; D011859:Radiography; D014399:Tuberculosis, Spinal / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents