Images in Clinical Radiology

A Rare Presentation of Tuberculosis: Multifocal Skeletal and Multisystemic Disease Evaluated with Imaging Findings

Authors: {'first_name': 'Burak', 'last_name': 'G\xc3\xbcnay'},{'first_name': 'B\xc3\xbc\xc5\x9fra', 'last_name': '\xc3\x96zdemir'},{'first_name': 'Fethi Emre', 'last_name': 'Ustaba\xc5\x9f\xc4\xb1o\xc4\x9flu'}


Teaching point: Tuberculosis (TB) is a rare clinical disease in the musculoskeletal system. Multifocal bone involment and multisystemic spread of this disease is extremely uncommon and difficult to diagnose.

Keywords: multisystemicmultıfocalskeletaltuberculosistreatment 
 Accepted on 24 Mar 2022            Submitted on 16 Oct 2021

Case History

A 27-year-old female patient was admitted to Trakya University Hospital with a history of recurrent fever, weight loss, and intermittent lumbar back pain lasting for one month. The patient also reported persistent headache, chills, and night sweats. She has no history of TB exposure or chronic lung disease. Cranial and lumbar magnetic resonance imaging (MRI), thoracic and lumbar computed tomography (CT), and whole-body 18F-FDG PET/CT were taken upon her complaints (Figures 1, 2, 3).

Figure 1
Figure 1 
Figure 2
Figure 2 
Figure 3
Figure 3 

Based on the symptoms and the examinations, meta-static disease or bone tuberculosis was suspected. Subsequently, to make the definitive diagnosis, open biopsy was performed under the L2 lamina and L2 vertebral bodies. Histopathological examination showed local sequestrum formation. Langerhans cells were detected with giant cells and dead bones, which are the characteristic features of TB disease.


In this case report, which showed unusual radiological findings that were more indicative of malignancy or metastatic disease, a rare case of atypically disseminated multifocal skeletal and multisystemic TB was identified. Thus, due to the complex and atypic clinical findings of multifocal skeletal TB, it is easy to misdiagnose the disease [1].

Funding Information

The authors have no relevant financial interest in this article.

Competing Interests

The authors have no competing interests to declare.


  1. Zhang L, et al. Multifocal skeletal tuberculosis: A case report. Exp Ther Med. 2016; 11(4): 1288–1292. DOI: