关键词: 结核, 脊柱, 多发性骨髓瘤, 共病现象, 诊断, 鉴别, 病例报告

Abstract:

In July 2025, a 74-year-old female patient with spinal lesions was admitted to the Department of Spine Surgery, Wuhan Pulmonary Hospital. The patient was hospitalized for “low back pain for 1 year, aggravated with right lower limb numbness for 1 month”, with a past medical history of type 2 diabetes mellitus and hypertension. After admission, lumbar magnetic resonance imaging (MRI) was performed, revealing L3 vertebral body collapse and paravertebral abscess; computed tomography (CT) scan showed osteolytic “perforating-like” destruction. Pathological examination of percutaneous needle biopsy specimens showed inflammatory changes, and metagenomic next-generation sequencing detected Mycobacterium tuberculosis complex. The initial diagnosis was spinal tuberculosis. The patient received standard anti-tuberculosis treatment for more than 1 month, but had minimal symptomatic improvement. Follow-up MRI showed no absorption of the abscess. Due to poor therapeutic response, surgical debridement of the lesion, spinal canal decompression and internal fixation were performed. Postoperative immunohistochemical staining confirmed multiple myeloma with focal granulomas, and the final diagnosis was lumbar tuberculosis complicated with multiple myeloma. The patient recovered well after surgery and was discharged 2 weeks later. Chemotherapy for myeloma was not administered due to advanced age. The patient was lost to follow-up after subsequent onset of hemoptysis and a space-occupying lesion in the left lung. The authors suggest that for destructive spinal lesions, especially in elderly patients with complex immune status, a single positive etiological result cannot rule out the possibility of coexisting malignant lesions. Percutaneous needle biopsy has inherent sampling bias. When the response to targeted therapy is unsatisfactory, concurrent dual pathologies should be highly suspected, and surgical biopsy should be performed promptly to confirm the definitive diagnosis.

Key words: Tuberculosis, spinal, Multiple myeloma, Comorbidity, Diagnosis, differential, Case reports