Tuberculosis of the axial skeleton mimicking malignancy

Multifocal bony lesions involving vertebral bodies and cancellous bones commonly occur in metastases and haematological malignancies. However, tuberculosis being a 'great mimic', can have a similar presentation. We present a young Indian female who had bony lesions involving multiple cancellous bones, without constitutional features. Extensive search for a neoplastic cause revealed negative results. Histopathological examination of the involved tissue revealed diagnosis of tuberculosis, which was not suspected. The patient improved remarkably with antitubercular therapy. Tuberculosis of the spine commonly presents with destructive spondylitis (Pott's spine), leading to spinal deformity. Multifocal involvement of the skeleton is an atypical presentation of musculoskeletal tuberculosis. This case highlights the fact that tuberculosis should always be considered in patients with multifocal bony lesions in countries where it is endemic, like India, even in the absence of constitutional features.