SHM Converge Scientific Abstract ePoster Gallery-Disseminated Tuberculosis: A Rare Cause of Worsening Lower Back Pain

Pdf Summary

This case describes a 77-year-old immunocompetent man from the Dominican Republic who developed worsening lower back pain over two months. Initial MRI showed L5-S1 spinal osteomyelitis, but fungal, bacterial, and AFB cultures from bone biopsy were negative. A QuantiFERON test was positive, and chest CT revealed innumerable pulmonary nodules that were initially thought to be post-COVID changes. He was treated empirically with vancomycin and ceftriaxone, but his pain progressed and he later required a walker.<br /><br />On readmission, repeat MRI showed worsening L5-S1 osteomyelitis with new intervertebral and bilateral psoas abscesses. Three sputum samples were negative for AFB, but IR drainage of a psoas abscess revealed AFB, and NAAT confirmed Mycobacterium tuberculosis. He was started on standard RIPE therapy for presumed disseminated tuberculosis after the Department of Health was notified.<br /><br />The authors conclude that disseminated tuberculosis, though rare, should be considered in patients with persistent or unexplained symptoms affecting multiple organ systems, even if they are not immunocompromised. This case highlights the importance of revisiting the diagnosis when presumed bacterial osteomyelitis does not improve with appropriate therapy.

Asset Subtitle

Alicia Canas

Meta Tag

Author List Alicia Canas, Christopher K. Migliore

Category Clinical Vignettes

Concept Disseminated Tuberculosis

Concept Vertebral osteomyelitis

Concept Low Back Pain

Concept Musculoskeletal Tuberculosis

Concept RIPE Therapy

Distinguished Non-Finalist

Presenter Organization Columbia University Irving Medical Center

Presenting Author Alicia Canas

Track Adult

Keywords

tuberculosis

spinal osteomyelitis

psoas abscess

Mycobacterium tuberculosis

disseminated tuberculosis

lower back pain

MRI

AFB

RIPE therapy

immunocompetent

Disseminated Tuberculosis

Vertebral osteomyelitis

Low Back Pain

Musculoskeletal Tuberculosis

RIPE Therapy