A Rare Case of Tuberculosis with Sacrococcygeal Involvement Miming a Neoplasm

Abstract

Infection of the lumbosacral junction by tuberculosis is quite rare and occurs in only 1 to 2% of all cases of spinal tuberculosis; moreover, isolated sacrococcygeal or coccygeal tuberculosis is much rarer. Failure to identify and treat these areas of involvement at an early stage may lead to serious complications such as vertebral collapse, spinal compression, and spinal deformity. In the present paper, we report an uncommon case of spinal tuberculosis with sacrococcygeal location revealed by a chronic low back pain that was successfully managed. Computed tomography scan and magnetic resonance imaging of the pelvis revealed a lytic lesion affecting both of sacrum and coccyx causing osseous destruction and suggesting a malignant process. A surgical biopsy was performed to establish the tissue diagnosis. Histopathological report confirmed the diagnosis of skeletal tuberculosis. The patient was treated with antibacillary chemotherapy for a period of 9 months. The follow-up period was of 36 months. There was a full recovery and the patient was asymptomatic.

Figure 1

AP and oblique X-rays of pelvis showing fuzziness of the sacrococcygeal region with irregular margins.

Figure 2

Contrast-enhanced computed tomography (CT) scans of the patient revealing presacrococcygeal lytic process.

Figure 3

Magnetic resonance images of the patient. Revealing a process of hypointense signals in T1W images (a) and hyperintense signals in T2W images (b), the lesion was moderately enhanced in its periphery after gadolinium administration (c).

Figure 4

Histological examination revealing caseating granulomatous inflammation.

Figure 5

Follow-up AP and oblique X-rays of pelvis at 3 years showing no evidence of recurrence.