Unveiling diagnostic challenges: A case report of noncontagious vertebral involvement in spinal tuberculosis mimicking metastasis

Spinal tuberculosis usually involves intervertebral disc, pardiscal vertebra and has associated perivertebral collection. Involvement of vertebral body including the posterior element, noncontagious vertebral involvement and sparing of intervertebral discs is typical of metastasis. Index case, a 19 years old Nepali patient presented to our hospital with complaints of severe backache. Blood and urine investigations were normal except elevated erythrocyte sedimentation rate and C- reactive protein. A contrast enhanced computed tomography (CT) showed lytic lesions in clivus, C7, T10, and L3 vertebral bodies with involvement of right sided posterior elements of C7 and T10. Mild surrounding soft tissue was seen. Contrast enhanced MRI showed similar findings and also lesions in S1 and right sacral ala. Possibility of metastatic lesion was considered over tuberculosis. A CT guided biopsy from right pedicle of T10 vertebra confirmed tubercular etiology.