Presentation of a rare sacral tuberculosis in an otherwise healthy patient: diagnostic challenge and review of treatment.

In the developed world, spinal tuberculosis is a rare and often overlooked cause of a spinal mass. The most common sites for vertebral tuberculosis are the lower thoracic and upper lumbar spine, while the cervical and sacral (<5%) areas are rarely infected. Magnetic Resonance Imaging has proven to be the best imaging modality to identify spinal TB while antibiotic treatment has made spinal tuberculosis a diagnostic problem instead of a therapeutic one. We present the case of a 30-year-old male who presented with the sole complaint of a two-month history of radiating lower back pain. Imaging findings included normal radiographs and a large, heterogeneously T2-enhancing lesion found to be tuberculosis. Treatment included CT-aspiration and chemotherapy. TB spondylitis is primarily treated with medical management, and surgical intervention is usually warranted only when there is an unacceptable degree of kyphosis or persistent neurological symptoms.