Causes of misdiagnosis and mistreatment of spinal tuberculosis with radiotherapy in nonendemic areas: A pitfall in diagnosis and treatment - Hazards of radiotherapy on the tuberculous lesion

Study Design. Report of initially misdiagnosed and mistreated cases.

Objectives. To report a previously undescribed misdiagnosis and subsequent mistreatment with radiation for tuberculosis of the spine and to promote awareness for tuberculosis in nonendemic areas.

Summary of Background Data. It is not seldom that radiation therapy is provided for suspected malignant spinal lesions without histologic confirmation. Literature is not available on harmful effects of radiation therapy for tuberculosis of the spine.

Methods. Clinical case analysis for initial misdiagnosis and mistreatment, analysis of subsequent clinical course.

Results. Two patients received radiotherapy on spinal lesions of suspected malignant origin. In both patients, the lesions were of tuberculous origin and the lesions increased during radiotherapy. In Case 2, the paraplegia did not heal.

Conclusion. In cases of a spinal lesion of unknown origin, tuberculosis should always be considered. Adequate biopsy for cultures and histology is mandatory. Radiotherapy locally aggravates tuberculous spinal lesions.