Multifocal Bone Lesions involving the Spine, Scapula, Sternum, and Long Bones of a Child: Could it be Tuberculosis?

Abstract Pediatric multifocal skeletal tuberculosis(TB) is a rare and diagnostically challenging manifestation of disseminated TB. This case report describes a 7.5-year-old girl with disseminated multidrug-resistant(MDR) TB involving the lungs, brain (tuberculomas), mesenteric lymph nodes, and five skeletal sites. Clinical features included weight loss, backache, and joint swellings. Imaging revealed spondylodiscitis, paravertebral collections, and metaphyseal lesions resembling Brodie’s abscess. Diagnosis was confirmed via gastric lavage Xpert MTB/RIF (Mycobacterium tuberculosis/Rifampicin) which identified rifampicin-resistant MTB, with further testing revealing isoniazid resistance. The patient was started on a second-line antitubercular regimen. In such patients, multifocal bone lesions can mimic malignancies or benign conditions, highlighting the need for heightened clinical suspicion and microbiological confirmation in endemic regions.