A 45-year-old woman presented with dyspnoea, chest pain, orthopnoea and bilateral leg oedema. On admission, she was found to have nephrotic syndrome and global pericardial effusion with impending tamponade for which pericardiocentesis was performed. The diagnosis of systemic lupus erythematosus was made based on the clinical and biochemical findings. She was also started on dialysis and immunosuppressants for lupus nephritis.
Tuberculosis (TB) is commonly thought of as a disease of the past or a disease of the developing world and immunocompromised populations. Resurgence in non-endemic populations has been trending in recent years. Although musculoskeletal manifestation of TB is less common– it has insidious onset and it is an indolent process, which in advanced stages can present with extensive pathology and severe morbidity. Diagnosis is often made by a combination of clinical features and imaging findings to initiate early treatment and to reduce complications such as vertebral collapse and cord compression. It is therefore vital for radiologists to be aware of imaging features and unusual presentations related to this destructive disease. This case report illustrates an unusual presentation in a young immunocompetent patient who presented with palpable neck masses and was later found to have extensive multilevel tuberculous spondylodiscitis. The salient features of this uncommon but debilitating disease are discussed and learning points highlighted.
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