Tuberculosis the great mimicker: 18F-fludeoxyglucose positron emission tomography/computed tomography in a case of atypical spinal tuberculosis

Tuberculosis (TB) has aptly been called the great mimicker. A 14-year-old boy, who had been treated for Hodgkin's Lymphoma 2 years back and had been in remission, underwent a whole body 18F-fludeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan, owing to a recent onset of backache and difficulty in walking. The study showed an FDG avid destructive lesion of the posterior elements of the sixth, seventh and eighth dorsal vertebrae along with a hypermetabolic collection in the adjacent paraspinal muscles with extension into the spinal canal, causing encasement of the thecal sac as well. Based on this constellation of findings, a diagnosis of atypical spinal TB was made, which was subsequently proven on histopathology. The present case illustrates that spinal TB, including the atypical form can be diagnosed on PET/CT even in clinically unsuspected cases.