case_images: PMC8310911_01
case_images: Timeline of the diagnosis and treatment process. (A) Contrast-enhanced abdominal CT revealed a hypodense lesion (white arrow) with mild to moderate enhancement in the right hepatic lobe near hepatic hilar. (B) Contrast-enhanced abdominal CT revealed a soft tissue density lesion (white arrow) with heterogeneous enhancement in the left posterior mediastinum. (C) MRI of thoracic spine revealed a soft tissue lesion (white arrow) at T3/T4. (D) MRI of thoracic spine showed a soft tissue lesion (white arrow) at T7/T8. (E) MRI of thoracic spine displayed multiple bone destructions (white arrows) at T3/T4 and T7/T8 with surrounding soft tissue lesions. (F) Radionuclide bone scan showed that the metabolism of vertebral bodies of T4 and T8 was abnormal. (G) Histopathological examination of the lesion at T7/T8 showed caseous necrosis with a significant number of inflammatory cells and multinucleate giant cells. CT, computed tomography; F-18 FDG-PET, 18F-fluorodeoxyglucose positron emission tomography; MRI, magnetic resonance imaging; T, thoracic vertebra; BALF, bronchoalveolar lavage fluid.
case_images: fmed-08-687984-g0001.jpg
case_images: PMC8310911_01_fmed-08-687984-g0001.jpg
case_images: F1
case_images: The entire process of diagnosis and treatment is briefly depicted in Figure 1. Contrast-enhanced abdominal computed tomography (CT) showed a hypodense lesion with mild to moderate enhancement in the right hepatic lobe near hepatic hilar, which indicated the possibility of cholangiocellular carcinoma; in addition, a soft tissue density lesion with heterogeneous enhancement in the left posterior mediastinum suggested the possibility of neurogenic tumor (Figures 1A,B). MRI of thoracic spine demonstrated multiple bone destructions at T3/T4 and T7/T8 with surrounding soft tissue lesions, suggesting spinal TB with cold abscesses (Figures 1C-E). Radionuclide bone scan demonstrated that the metabolism of vertebral bodies of T4 and T8 was abnormal, and metastatic bone tumors were considered (Figure 1F). The mNGS revealed 25 total reads of MTB complex (Table 2). Significantly, because of the high internal homology and relatively insufficient coverage, the species within the MTB complex was not determined. Meanwhile, histopathological examination showed caseous necrosis with a significant number of inflammatory cells and multinucleate giant cells (Figure 1G). Therefore, the patient was diagnosed with spinal TB and immediately treated with anti-TB drugs including isoniazid, rifampicin, ethambutol, and pyrazinamide.