Case Report

Active Pulmonary Tuberculosis with Vertebra and Rib Involvement: Case Report

Authors: Duygu Özol, MD, Aslı Köktener, MD, Mehtap E. Uyar, MD


Multifocal skeletal tuberculosis is defined as osteoarticular lesions that occur simultaneously at two or more locations and is generally associated with disseminated disease. Although involvement of bones accounts for 1 to 5% of all tuberculosis cases, multifocal involvement of the skeleton is extremely rare. We present a case of active pulmonary tuberculosis (TB) with vertebral and rib involvement and multiple hypodense lytic lesions accompanied by a paravertebral mass lesion. In the differential diagnosis, metastases, lymphoma, multiple myeloma, chordoma sarcoidosis and rare spinal infections such as brucellosis and fungal disease were considered. The diagnosis was established by surgical biopsy, taken by video- assisted thoracoscopic surgery. Especially for patients from TB-endemic areas, tuberculosis must be considered in the differential diagnosis and treatment should be started without delay.

Key Points

* Differential diagnosis of multiple lytic lesions in vertebrae and ribs should include tuberculosis.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Nerlich AG, Rohrbach H, Zink A. Paleopathology of ancient Egyptian mummies and skeletons. Investigations on the occurrence and frequency of specific diseases during various time periods in the necropolis of Thebes-West. Pathologe 2002;23:379-385
2. Harisinghani MG, McLoud TC, Shepard JO, et al. l. Tuberculosis from Head to Toe. Radiographics2000;20:449–470.
3. Moujtahid M, Essadki B, Lamine A, et al. Multifocal bone tuberculosis: apropos of a case. Rev Chir Orthop Reparatrice Appar Mot 1995;81:553.
4. Tatelman M, Drouillard EJP. Tuberculosis of the ribs. AJR 1953;70:923–935.
5. Sankaran B. Tuberculosis of bones and joints. Ind J Tub 1993;40:109–118.
6. Martini M, Quahes M. Bone and joint tuberculosis: a review of 652 cases. Orthopedics 1988;2:861–866.
7. Ahmadi J, Bajaj A, Destian S, et al. Spinal tuberculosis: atypical observations at MR imaging.Radiology 1993;189:489–493.
8. Azzam NI, Tammawy M. Tuberculous spondylitis in adults: diagnosis and treatment. Br J Neurosurg1988;2:85–91.
9. Wiebe ER, Elwood RK. Tuberculosis of the ribs—a report of three cases. Respir Med 1991;85:251–253.