Spinal Tuberculosis Mimicking Metastatic Lung Cancer: A Case of Misdiagnosis.

Misdiagnosis of spinal tuberculosis (TB), otherwise known as Pott's disease, can lead to inappropriate treatments and prolonged morbidity. Spinal TB may mimic malignant lesions on imaging, and, in addition, its chronic course, weight loss, and constitutional symptoms can further contribute to misdiagnosis, occasionally resulting in inappropriate chemotherapy or radiotherapy before the correct diagnosis is established. A 44-year-old woman presented with progressive thoracic spine pain, lower limb radiation, weight loss, and intermittent low-grade fever. She was initially misdiagnosed with a lung neoplasm with spinal metastases based on imaging and received chemotherapy and radiotherapy without improvement. Definitive diagnosis was made via thoracoscopic biopsy of lung and spinal lesions, revealing rifampicin- and isoniazid-resistant TB. Imaging confirmed destructive thoracic vertebral lesions with prevertebral and epidural extension, consistent with spinal TB with large cold abscesses. The patient was treated with a tailored multidrug-resistant TB regimen, including bedaquiline, linezolid, levofloxacin, clofazimine, and cycloserine, alongside supportive therapy. She tolerated the treatment well without significant adverse effects. This case highlights the diagnostic challenge of spinal TB mimicking malignancy and underscores the importance of biopsy for accurate diagnosis and the timely initiation of appropriate therapy.