Image in medicine
Multifocal skeletal tuberculosis simulating a soft-tissue sarcoma
Tuberculosis ósea multifocal que simula un sarcoma de partes blandas
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Physical examination revealed a mass of firm consistency in the right rib area, 12<span class="elsevierStyleHsp" style=""></span>cm in diameter, painless and unfluctuating, coated with intact skin without fistula (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a) With clinical suspicion of a soft tissue sarcoma, fine needle aspiration revealed the presence of epithelioid granulomas suggestive of tuberculosis. The culture of the sample was positive for <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span>. Computed tomography confirmed the presence of a mass in the right lateral chest wall 8.6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>cm, covering the lateral arches of the ribs 8th to 11th, with periosteal reaction and destruction of the lateral arch of the 9th rib (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). It was accompanied by an osteolytic lesion 1.8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2.2<span class="elsevierStyleHsp" style=""></span>cm in the right margin of the sternal body (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>c), and a third injure in the left side of the L4 vertebral body with soft tissue infiltrating the psoas muscle. Serology for HIV was negative and other causes of cellular immunodeficiency were ruled out. After starting anti-tuberculosis treatment, we obtained the resolution of lesions after 7 months (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Multifocal skeletal tuberculosis is a very rare extrapulmonary manifestation that can simulate malignant lesions. As this case illustrates, it should be part of the differential diagnosis of multiple osteolytic lesions in patients from areas with a high incidence of tuberculosis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández-Ruiz M, López-Roa P, Aguado JM. Tuberculosis ósea multifocal que simula un sarcoma de partes blandas. 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