Progressive backache and abscess formation: infectious or neoplastic disease?

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K.J. ter Meulen, P. Douwes Draaijer

Woensdag 20 april 2016

15:50 - 16:00u in Zaal 0.5

Categorieën: Parallelsessie

Parallel sessie: Parallelsessie 4: Case reports/research

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In August 2014, a 52-year old African female hemodialysis patient presented with complaints of backache. MRI was conducted and showed abscess formation next to the first lumbar vertebra. Concluded as spondylitis, suspect for tuberculosis. Biopsies were taken and showed an infectious process, negative for tuberculosis. Flucloxacillin was given and patient responded well and MRI showed decrease of abscess in October.

In March, patient returned with similar symptoms. MRI showed progression of abscess and a spot on right-rib 12. Biopsies were repeated of the abscess and remained negative. Due to suspicion for tuberculosis and threath of spinal cord injury, tuberculostatica was started.

In September, patient came with severe backache and loss of strength in her legs. Biopsy was taken from the spot on the rib and showed metastasis of pheochromocytoma. Patient had a pheochromocytoma removed in 2010 that was discovered after a PET-scan was conducted due to continuous fever with unknown cause. The MIBG-scan was performed afterwards and did not show any increased uptake.

Revision of previous biopsies was requested and also showed metastasis of the pheochromocytoma. Normetanephrine and 3-methoxytyramine were elevated in serum (patient was anuric). Due to the extension of metastases and the poor clinical condition of the patient, we have decided to only give supportive care with radiotherapy for the partial paraplegia of her legs. She is currently recovering in a rehabilitation home.

Metastasis of a pheochromocytoma is very rare. Nowadays it is still a debate which diagnostic tool is the most sensitive for this kind of tumor.