Multidrug-resistant tuberculous spondylodiscitis: need for aggressive management and drug susceptibility testing of Mycobacterium tuberculosis isolates.

A 49-year-old woman complaining of thoracic spine pain for 18 months was admitted to the hospital for evaluation. Magnetic resonance imaging of the thoracic spine showed spondylodiscitis of the T8-T9 intervertebral disk. Computed tomography scan-guided fine needle aspiration of the affected area was performed but it did not reveal the cause of the disease. Because of continuing symptoms and lack of diagnosis the patient underwent a vertebrectomy and substitution of the eighth thoracic vertebra with Moss titanium cylinder filled-up with auto-bone grafts. Culture of the extracted bone grew Mycobacterium tuberculosis, which was resistant to isoniazid and rifampin. Persistent and even invasive diagnostic work up is needed for the proper and prompt management of patients with spondylodiscitis.