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Reminder of important clinical lesson
CASE REPORT
Pleuropulmonary tuberculosis with spinal lesions due to metastatic malignancy differentiated definitively on imaging
  1. Justine Gibson1,2,
  2. John Coucher3,
  3. Chris Coulter2,4 and
  4. Geoffrey Eather1,2
  1. 1 Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  2. 2 Metro South Clinical Tuberculosis Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  3. 3 Department of Diagnostic Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  4. 4 Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Justine Gibson, gibson.justine{at}gmail.com

Abstract

A healthy 31-year-old man presenting with back pain was found to have multiple spinal enhancing lesions on MRI. An incidental asymptomatic large pleural effusion was identified on investigations for the back pain and pleural and pulmonary tuberculosis (TB) was subsequently diagnosed. The radiographical features on MRI spine were not typical of spinal TB and a Ga68 DOTATATE Positron Emission Tomography (PET)/CT confirmed metastatic paraganglioma with multiple bone metastases. Although metastatic paraganglioma is rare, this case highlights that even in young patients dual pathology needs to be considered. Most importantly, it is a reminder to physicians managing TB of the clues that help distinguish spinal TB from important alternative causes, including metastatic malignancy.

  • head and neck cancer
  • tuberculosis
  • endocrine cancer

https://doi.org/10.1136/bcr-2018-226160

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    Footnotes

    • Patient consent for publication Obtained.

    • Contributors All authors have made an individual contribution to this case report. JG, CC and GE were involved in the management of this patient as well as planning of the case report and background research. JG has written the majority of this manuscript and JC has provided the interpretation of the radiology images. All authors have contributed to the manuscript editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.