Case report

A fatal case of spinal tuberculosis mistaken for metastatic lung cancer: recalling ancient Pott's disease

Felix C Ringshausen^1,2 , Andrea Tannapfel³ , Volkmar Nicolas⁴ , Andreas Weber⁴ , Hans-Werner Duchna¹ , Gerhard Schultze-Werninghaus¹ and Gernot Rohde¹

¹  Department of Medicine III, Pneumology, Allergology and Sleep Medicine, University Hospital Bergmannsheil, Ruhr-University Bochum, Germany

²  Department of Medicine, Spital Bülach, Bülach, Switzerland

³  Institute of Pathology, Ruhr-University Bochum, Germany

⁴  Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Ruhr-University Bochum, Germany

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Annals of Clinical Microbiology and Antimicrobials 2009, 8:32doi:10.1186/1476-0711-8-32

Published:	20 November 2009

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.

Case presentation

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.

Conclusion

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.