Diagnostic Challenges of Spinal Tuberculosis Simulation of Cancer in Patients Undergoing Hemodialysis: A Case Report and Literature Analysis

Abstract Spinal tuberculosis (TB) rarely occurs in hemodialysis (HD) patients, which makes diagnosis challenging. Therefore, we report a case of spinal TB with a psoas muscle abscess in an HD patient. The patient had been on the HD programme for two years and was complaining of intermittent fever and low back pain. Positron emission tomography/computed tomography (PET/CT) revealed increased metabolism of the hepatic hilum and pancreatic neck, multiple enlarged lymph nodes (LNs), and destruction of the L3 vertebra invading the psoas muscle bilaterally. To confirm the diagnosis of the disease, a biopsy of the psoas abscess via fine needle aspiration under computed tomography (CT) guidance was carried out, which revealed the formation of a caseating granuloma. Anti-TB drug therapy resolved the systemic symptoms. The final diagnosis was spinal TB. A diagnosis of extrapulmonary TB should be suspected when nonspecific uremic symptoms persist in HD patients. Moreover, the combination of multiple diagnostic methods is essential for accurately diagnosing TB.