A 25-year-old female presented with the left dull mid-back pain for 3 months' duration. The pain was moderate and radiated to the left breast/precordium. The physical examination just revealed focal tenderness over the inferior angle of the left scapula/7th costovertebral junction, without swelling or erythema.
The patient had a raised erythrocyte sedimentation rate of 40 and C-reactive protein of 6. Serological testing for HIV, hepatitis B, and hepatitis C was all negative.
The anteroposterior X-rays of the thoracic spine showed that the T7 vertebral body was scalloped on the left side, and there erosion of the T7 left pedicle and adjoining rib [Figure 1]. The MR showed; a left-sided T7 enhancing periarticular erosive lesion, marrow edema in the posteromedial portion of the left 7th rib, the left posterolateral portion of the T7 vertebral body, and lateral left T7 pedicle. There was also thickening/ enhancement of the synovium of the left 7th costotransverse joint with enhancing soft tissue elevating the overlying pleura, and abutting the descending aorta [Figure 2]. A CT-guided biopsy was diagnostic for TB; it demonstrated caseous necrosis with epithelioid and Langerhans giant cells [Figure 3]. In addition, GeneXpert detected Mycobacterium tuberculosis that showed sensitivity to both isoniazid and rifampicin.
ATT for the first 4 months included rifampicin, isoniazid, pyrazinamide, and ethambutol (HRZE) (intensive phase). For the next 8 months, the patient received rifampicin and isoniazid (HR) (continuation phase). At follow-up (12 months), the patient showed clinical and radiological signs of healing [Figure 4].