Uncorrect diagnosis of tubercolar spondylodiscitis in aggressive and bone destructive metastasis of melanoma: A case report and literature review

  • Valerio Cipolloni Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Catholic University of Rome, Italy.
  • Luigi Aurelio Nasto Department of Pediatric Orthopaedics, IRCCS Istituto “G. Gaslini” Children’s Hospital, Genova, Italy.
  • Luca Piccone Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Catholic University of Rome, Italy.
  • Charlotte Pripp Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Catholic University of Rome, Italy.
  • Eleonora Gentili Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Catholic University of Rome, Italy.
  • Giulio Maccauro Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Catholic University of Rome, Italy.
  • Enrico Pola | enrico.pola@tiscali.it Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Catholic University of Rome, Italy.

Abstract

Differential diagnosis of destructive osteolytic spinal lesions can be a diagnostic challenge. In this study, we described a rare case of spinal metastases from primary desmoplastic melanoma which had incorrectly been diagnosed and treated as tuberculous spondylodiscitis. An 82-year-old male patient with ongoing low back pain and a history of lumbar localized Pott’s performed a lumbar spine MRI that showed osteolytic lesion with first hypothesis of spondylodiscitis L2-L3. The patient was hospitalized and cause of worsening of the lumbar pain underwent a following series of non-diagnostic CT-guided and open lumbar biopsy at L2-L3 with unsuccessful antibiotic-antitubercular therapy. A new MRI revealed a worsening of previous lesions, extension of the osteolytic lesion at the level of L1-L2 and L3-L4 with neurological impairment. The diagnosis of metastatic melanoma was obtained with surgical decompression and open posterior biopsy procedure. The case described is pathognomonic of the difficulty in detecting the correct diagnosis in front of similar clinical and radiological manifestations. The presence of a previous Pott’s disease in the same involved vertebral site was of crucial importance in deflecting the correct diagnostic classification of the pathology, which was possible to ascertain only following an extensive biopsy sampling in the last surgery performed.

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Published
2020-06-25
Keywords:
Spinal metastases, Malignant Melanoma, Osteolytic spinal lesion; Tubercolar spondylodiscitis
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How to Cite
Cipolloni, V., Nasto, L. A., Piccone, L., Pripp, C., Gentili, E., Maccauro, G., & Pola, E. (2020). Uncorrect diagnosis of tubercolar spondylodiscitis in aggressive and bone destructive metastasis of melanoma: A case report and literature review. Orthopedic Reviews, 12(1s). https://doi.org/10.4081/or.2020.8674

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