title: Multifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case report.
abstract: BACKGROUND
  The occurrence of non-contiguous, multiple, and remote involvement tuberculous spondylitis is rare. The clinical presentation in patients with multifocal musculoskeletal tuberculosis may closely mimic that in patients with multiple bone metastases, which makes the accurate clinical diagnosis challenging. Herein, we report a multifocal musculoskeletal tuberculosis case that was misdiagnosed for 8 months as multiple bone metastases.
  
  
  METHODS
  A 63-year-old male farmer of Chinese Han ethnicity presented to us with pain in left side of the neck, right side of the chest and the back for 10 months without typical tuberculosis symptoms. His past medical history, the CT and fluoroscopy-guided biopsy were negative for tuberculosis. Interferon gamma by T-SPOT was also negative. Radiological findings including CT, MRI and PET-CT suggested that the patient had multiple metastases. Accordingly, the patient was misdiagnosed as having musculoskeletal tumors until a swelling under the right nipple ulcerated. The smear test for acid-fast bacilli and the PCR test for TB-DNA of the pus from the swollen area were both positive, leading to the final correct diagnosis of musculoskeletal tuberculosis.
  
  
  CONCLUSIONS
  The proper diagnosis of musculoskeletal tuberculosis is clinically challenging due to Mycobacterium tuberculosis variants involved and atypical presentations, especially when the lesions are multiple. Our findings indicate that multiple tuberculous spondylitis must be considered in the differential diagnosis of multiple musculoskeletal lesions.
authors.affiliation: Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China. yemeiping1988@163.com.|Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China. yemeiping1988@163.com.
authors.forename: Meiping
authors.initials: M
authors.lastname: Ye
authors.affiliation: Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China. jinwei1314w@aliyun.com.
authors.forename: Jinwei
authors.initials: J
authors.lastname: Huang
authors.affiliation: Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China. wj498624370@126.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Wang
authors.affiliation: Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China. renxiaoyaostc@163.com.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Ren
authors.affiliation: Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China. jianfei1133@163.com.
authors.forename: Jianfei
authors.initials: J
authors.lastname: Tu
authors.affiliation: Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China. youhuibo128@sina.com.
authors.forename: Weibo
authors.initials: W
authors.lastname: You
authors.affiliation: Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China. zhu05787@126.com.
authors.forename: Taohui
authors.initials: T
authors.lastname: Zhu
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000175:diagnosis; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D014399:Tuberculosis, Spinal / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D004269:DNA, Bacterial
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