Multifocal tuberculous osteomyelitis mimicking widespread bony metastases: review of literature and case report

Introduction Mycobacterium tuberculosis infections remain a significant cause of morbidity and mortality worldwide. Extrapulmonary infections are less common, and skeletal tuberculosis accounts for about 5–20% of all cases. Skeletal tuberculosis cases often pose diagnostic challenges due to its insidious onset, non-specific clinical presentation and radiographic findings similar to other diseases. Multifocal skeletal tuberculosis is an extremely rare clinical entity, and is defined as an infection that affects two or more non-contiguous bony structures. This clinical entity can mimic bony metastasis and may lead to delays in diagnosis and treatment. Case presentation We present a case of multifocal skeletal tuberculous infection mimicking widespread bony metastasis, occurring in an immunocompetent 28-year-old male, and discuss the diagnostic challenges faced and management strategies. The patient successfully underwent instrumentation and stabilization of a pathological T11 vertebra fracture and treatment of tuberculosis infection. Discussion While TB infections remain less common in developed countries, they can still cause significant morbidity. Multifocal skeletal tuberculous infections can resemble spinal or bony metastasis on various imaging modalities. Care must be taken when interpreting such imaging results, with histopathology and mycobacterial cultures remaining the gold standard to determine the presence of active TB infections.