Multifocal skeletal tuberculosis with posterior-element spinal, sternal, and pelvic involvement presenting as a pulmonary mass: A malignancy mimic.

Multifocal skeletal tuberculosis is an uncommon manifestation of osteoarticular tuberculosis characterized by noncontiguous involvement of multiple skeletal sites. When associated with a mass-like pulmonary lesion, it may closely simulate disseminated malignancy. We report a 26-year-old immunocompetent male presenting with progressive neck stiffness, fever, cough, weight loss, and dysphagia. Imaging demonstrated a large right upper lobe mass with internal air bronchograms and associated centrilobular tree-in-bud nodules, along with multifocal destructive lesions involving the cervical, thoracic, and lumbar spine, sternum, sacroiliac joint, and pelvic bones. Extensive posterior-element involvement was present, with associated prevertebral, paraspinal, and epidural soft-tissue collections resulting in early spinal cord compression. Laboratory evaluation revealed elevated inflammatory markers, a strongly positive Mantoux test, and negative HIV serology. Bronchoalveolar lavage was negative for malignancy and acid-fast bacilli. Histopathological examination of a CT-guided biopsy demonstrated granulomatous inflammation with Langhans-type giant cells, while GeneXpert MTB detected