The diagnosis of atypical skeletal tuberculosis is challenging

Despite advances in diagnostic imaging methods, the diagnosis of atypical multifocal skeletal tuberculosis (TB) is challenging [1]. Herein, we describe a patient with atypical TB affecting multiple vertebrae and other bones. A 24-year-old male presented with neck and back pain that was more severe in the morning and late at night and was alleviated by movement. His range of spinal activity was reduced. His skin appeared normal. Thoracic and lumber radiography showed compression and flattening of the spinal body of T6 and abnormal radiolucency of the spinal bodies of T9eT11 and L1eL2, but his chest radiographs appeared normal. Computed tomography (CT) revealed multiple lytic lesions in the vertebral bodies of C7, T6, T9eT11, and L1eL2 and the left transverse processes of T10eT11 and L1. Magnetic resonance imaging (MRI) showed collapse and flattening of the T6 vertebral body and multiple lytic lesions in the vertebral bodies of C7, T1, T6eT12, and L1eL2 and the left vertebral arch of T10. An abnormal paravertebral signal was present adjacent to C1 and C7. Positron emission tomography (PET)/CT showed multiple skipped lytic lesions with increased metabolic activity (maximal standardized uptake value Z 13.8) in the vertebral bodies of C1, C7, T6eT12, L1eL2, L5, and S1; the left transverse processes of T10, T11, and L1; the right eighth and left ninth ribs; the bilateral ilia; and the left acetabulum and femoral neck (Fig. 1). Radionuclide bone scanning showed multiple foci of increased tracer uptake in the