A fatal case of spinal tuberculosis mistaken for metastatic lung cancer: recalling ancient Pott's disease.
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.
Ringshausen
Felix C
FC
Department of Medicine III, Pneumology, Allergology and Sleep Medicine, University Hospital Bergmannsheil, Ruhr-University Bochum, Germany. felix.ringshausen@web.de
Tannapfel
Andrea
A
Nicolas
Volkmar
V
Weber
Andreas
A
Duchna
Hans-Werner
HW
Schultze-Werninghaus
Gerhard
G
Rohde
Gernot
G
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
D000900:Anti-Bacterial Agents