[Spinal tuberculosis with vertebral instability: comprehensive approach]

Tuberculosis with simultaneous pulmonary, vertebral, and cerebral involvement is observed episodically in HIV-negative patients, thus requiring evaluation of the entire cerebrospinal axis and a multidisciplinary approach. We report the case of a 54-year-old man who presented with a three-month history of productive cough, constitutional symptoms, dyspnea, and lower back pain. Bilateral pulmonary cavitary lesions, pleural thickening, dorsal spondylitis (T10-T11) with fracture, compression, and edema of these vertebral bodies, paravertebral fluid collections partially compressing the spinal cord, and multiple focal cerebral and cerebellar lesions were identified. Sputum was positive for acid-fast bacilli (AFB), and molecular testing confirmed tuberculosis susceptible to isoniazid and rifampicin. First-line antituberculosis treatment and spinal stabilization surgery were performed, including T10 corpectomy and titanium mesh placement. The patient's recovery was favorable. We emphasize the importance of suspecting disseminated tuberculosis in non-HIV patients and highlight the value of the clinical-surgical approach and multidisciplinary follow-up.