PMC4812510_01
Computed tomography reconstruction of sacroiliac joint scan showing round hypodense lesions with central higher density and some cortical destruction in the (A) lumbar and sacral vertebrae and (B) left ilium.
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CT reconstruction of the sacroiliac joint indicated multiple round hypodense lesions with a hyperdense center, as well as some cortical destruction and soft tissue swelling in the lumbar and sacral vertebrae, and the left ilium regions (Fig. 1).
Contrast-enhanced chest computed tomography scans showing irregular patchy hypodense change in the left lung lobe with patchy translucent shadow inside.
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A contrast-enhanced CT scan of the chest, with Omnipaque  (1.5 ml/kg; GE Healthcare Life Sciences, Shanghai, China) as the contrast enhancement agent, demonstrated an irregular patchy hypodense signal in the left lung lobe with a patchy translucent shadow inside, which was enhanced heterogeneously (Fig. 2).
Computed tomography scan of the chest showing multiple round hypodense lesions with higher central density in the thoracic vertebrae, ribs and sternum.
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A chest CT scan showed multiple round hypodense lesions with higher central density in the thoracic vertebrae, ribs and sternum (Fig. 3).
Computed tomography scan of the vertebral body of Th7 showing bone destruction with partial cortical perforation.
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Furthermore, a CT reconstruction of the thoracic spine indicated bone destruction with partial cortical perforation (Fig. 4).
Magnetic resonance imaging scans showing multiple round ring signal shadows with a continuous finishing border from Th12 to S4. Sagittal (A) T1-weighted and (B) T2-weighted images revealed hypodense change in the internal region of the lesions and slightly hypodense change in the peripheral region, accompanied by some soft tissue swelling, (C) with evident ring enhancement and soft tissue enhancement, following administration of a contrast agent.
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In addition, sagittal T1-weighted and T2-weighted images revealed a hypodense signal in the internal of the lesions and a slightly hypodense signal in the peripheral region, which was accompanied by soft tissue swelling, with visible ring enhancement and soft tissue enhancement following intravenous administration of gadolinium (GE Healthcare Life Sciences) (Fig. 5).
Histopathological examination showing a large amount of necrosis, epithelioid cells, Langerhans giant cells and dead bone (hematoxylin and eosin staining; magnification, x200).
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Tokyo, Japan), a large amount of necrosis, epithelioid cells, Langerhans giant cells and dead bone were observed (Fig. 6), which are characteristics of TB. The results of Acid-Fast
Magnetic resonance imaging scans at 20 months after antituberculosis therapy showed only a slightly smaller range of the extensive abnormal signal intensity on (A) T1-weighted (low-to-high unequal signal intensity) and on (B) T2-weighted images (high signal intensity), as compared with the findings before treatment.
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March 2013, the patient was free of symptoms and the ESR had decreased to the normal value. MRI scans obtained following 20 months of anti-TB therapy showed that the range of the extensive abnormal signal intensity had become smaller, as compared with that before anti-TB treatment was initiated (Fig. 7).