J Korean Soc Radiol.  2016 Apr;74(4):273-278. 10.3348/jksr.2016.74.4.273.

A Rare Radiological Manifestation of Disseminated Tuberculous Spondylitisin Acquired Immune Deficiency Syndrome Patient: A Case Report

• Kim S
• Koo J
• Kim T

• KMID: 2208787
• DOI: http://doi.org/10.3348/jksr.2016.74.4.273

Abstract

The spine is the most common site of skeletal involvement in tuberculosis. The radiologic features are reportedly characterized by destruction of the vertebral body, subligamentous extension or subchondral penetration, frequent paravertebral abscess formation and late involvement of the disk space. We experienced a case of a 25-year-old male who was a human immunodeficiency virus carrier without antiretroviral therapy. Incidental findings on abdominal computed tomography included multiple well-demarcated and ovoid osteolytic lesions with hyperdense rims disseminated in the thoracic, lumbar, and sacrum vertebrae, as well as in both ilii. On the lumbar spine magnetic resonance imaging, multiple small round lesions of isointense signal intensity with peripheral hyperintense rims were found on both T1- and T2-weighted imaging. The lesions had peripheral rim enhancement on gadolinium-enhanced T1-weighted imaging. Based on our experience, this rare image finding is one of the manifestations of disseminated tuberculosis.

MeSH Terms

Abscess
Acquired Immunodeficiency Syndrome*
Adult
HIV
Humans
Incidental Findings
Magnetic Resonance Imaging
Male
Sacrum
Spine
Tuberculosis

Figure

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  Fig. 1 Coronal-reformatted abdominal CT image shows multiple well-defined, ovoid, osteolytic lesions in the L3 vertebra, sacrum and right ilium (arrows).

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  Fig. 2 T1-weighted, T2-weighted, and gadolinium-enhanced T1-weighted fat-saturated sagittal lubar spine MRI images. A, B. T1-weighted (A) and T2-weighted (B) sagittal lumbar spine MRI images reveal well-defined, isointense, ovoid lesions on the lumbar spine. Thin, rim-like hyperintensity was also noted on peripheral portion of the lesions. No vertebral destruction, disk involvement or paraspinal abscess were noted on the images. C. Gadolinium-enhanced, T1 fat-saturated sagittal imaging shows peripheral enhancement of the ovoid lesions on the lumbar spine and sacrum, accentuating the target-like appearance of the lesions.

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  Fig. 3 Pathologic features of spinal tuberculosis. A. The biopsied spinal tissue showed caseation necrosis, a small granulomatous focus (empty arrows) with multinucleated giant cells (black arrows) (hematoxylin-eosin staining, × 400). B. Ziehl-Nielsen staining revealed acid-fast bacilli in the caseation necrosis area (Ziehl-Nielsen staining, × 400).

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  Fig. 4 Miliary tuberculosis on follow-up chest CT after 2 months. A. Coronal-reformatted chest CT image shows multiple well-defined, ovoid, osteolytic lesions in thoracic vertebrae (arrows). B. Coronal-reformatted chest CT image shows numerous random distributed miliary nodules. C. Axial CT image shows several ill-demarcated round low density lesions in the spleen.

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  Fig. 5 Coronal-reformatted abdominal CT image shows multiple well-defined, ovoid, osteolytic lesions in the L3 vertebra, sacrum and right ilium (arrows).

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