Multifocal Skeletal Tuberculosis Mimicking Metastatic Malignancy: A Case Report

Skeletal tuberculosis is an uncommon form of extrapulmonary tuberculosis that may involve multiple osseous sites and occasionally mimic malignant disease, creating a significant diagnostic challenge. We report the case of a 70-year-old male who presented with an eight-month history of progressive thoracolumbar pain, constitutional symptoms, and subsequent development of paraplegia and urinary retention. Computed tomography revealed multifocal osteolytic lesions involving the sternum, thoracic and lumbar vertebrae, and iliac bones, initially raising concern for metastatic malignancy. Magnetic resonance imaging demonstrated destructive thoracic spondylodiscitis with additional noncontiguous vertebral involvement and associated epidural and paravertebral extension resulting in spinal canal compromise. Definitive diagnosis was established through computed tomography-guided biopsy followed by conventional polymerase chain reaction, which detected Mycobacterium tuberculosis complex. Antituberculous therapy was initiated, and the patient was subsequently evaluated by the Neurosurgery service, where he was deemed a candidate for surgical decompression and is currently undergoing preoperative assessment. This case highlights the importance of considering multifocal skeletal tuberculosis in the differential diagnosis of multifocal osteolytic lesions suggestive of malignancy, particularly in endemic regions.