Doctors Warn COVID-19 Can Trigger Dangerous Spine Infections Resembling Tuberculosis
Nikhil Prasad Fact checked by:Thailand Medical News Team May 13, 2025 3 hours, 41 minutes ago
Medical News: In a startling medical revelation, doctors in the United States are warning that COVID-19 infections can lead to serious spinal complications that mimic tuberculosis in both symptoms and radiological appearance. This emerging complication, spinal osteomyelitis—a rare but potentially life-threatening infection of the vertebrae—has now been documented in post-COVID-19 cases, further highlighting the unpredictable aftermath of the SARS-CoV-2 virus.
Doctors Warn COVID-19 Can Trigger Dangerous Spine Infections Resembling Tuberculosis
Researchers from the University of California Los Angeles (UCLA) David Geffen School of Medicine, Westlake, including Dr. Kole P. Joachim and Dr. Alina Katsman, have reported a rare but eye-opening case involving a 69-year-old woman who developed thoracic spinal osteomyelitis shortly after recovering from COVID-19. This
Medical News report delves into the case details and underscores the importance of early diagnosis and intervention for such infections that are often difficult to detect.
A Mysterious Onset of Pain After COVID Recovery
The patient had no significant prior medical conditions and had just recovered from COVID-19 after being treated with the antiviral Paxlovid. Only ten days later, she began experiencing troubling symptoms: severe upper back pain, shortness of breath, night sweats, and weight loss. The pain worsened at night and became more intense when she coughed.
Initial CT scans failed to provide clear answers, although they revealed a suspicious infiltrative mass in her thoracic spine, raising concerns about possible malignancy. A more detailed MRI scan later showed a mass infiltrating the T4-T5 vertebrae with signs of spinal cord compression—suggesting either infection or cancer. However, initial biopsies and blood cultures were inconclusive, making diagnosis extremely difficult.
Diagnosing the Hidden Culprit
Spinal osteomyelitis is a rare disease, with only 3–5% of all bone infections affecting the spine. Even more challenging is its presentation—it often mimics tuberculosis or cancer, and diagnostic tests like blood cultures or biopsies frequently return false negatives. In this case, a CT-guided biopsy yielded only granulation and fibrous tissue, with no definitive microbial identification.
To pursue further clarity, the medical team performed advanced imaging with a PET/CT scan. This revealed intense metabolic activity in the T4-T5 region of the spine, consistent with a serious infection. The patient was eventually taken in for open surgery due to worsening neurological symptoms and spinal cord compression.
During the procedure, surgeons discovered purulence (pus) at the T4-T5 vertebral level and a mediastinal abscess. Cultures taken during surgery finally confirmed the presence of methicillin-sensitive Staphylococcus aureus (MSSA), allowing doctors to make a definitive diagnosis of spinal osteomyelitis with mediastinal extension.
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Complex Treatment and Recovery
The treatment plan was aggressive but necessary. The patient underwent posterior spinal fusion, corpectomy (removal of vertebral body), and debridement to clean out the infection. She was then prescribed a rigorous antibiotic regimen, including cefadroxil, linezolid, and rifampin, to manage and suppress the infection over an extended period.
Interestingly, during the workup for her spinal infection, doctors also discovered a stable nodule in her right lung, which eventually turned out to be early-stage lung adenocarcinoma. The nodule was removed through a lobectomy, and thankfully, no further treatment was needed for the cancer. However, this dual diagnosis highlighted how one serious illness can lead to the discovery of another hidden condition.
What Makes Spinal Infections Post-COVID So Concerning
Spinal osteomyelitis is already challenging due to its vague symptoms—fever, chronic back pain, weight loss, and sometimes neurological deficits like weakness or paralysis. In a post-COVID context, such symptoms can be easily mistaken for lingering effects of the virus, leading to delays in proper diagnosis and treatment.
What makes this even more concerning is that the traditional tools used to detect spinal infections, like blood cultures and CT-guided biopsies, are not always reliable. In this case, advanced imaging and an open surgical biopsy were ultimately required to reach a diagnosis. This underscores the need for a high index of suspicion and multidisciplinary collaboration when dealing with persistent, unexplained back pain following COVID-19.
Emerging Diagnostic Tools May Improve Outcomes
To improve diagnostic accuracy, the study’s authors highlight the potential of new techniques such as shotgun metagenomic sequencing (sMGS), which can detect microbial DNA directly from blood samples. Preliminary studies have shown that this approach improves diagnostic accuracy by over 11% compared to traditional methods.
The authors advocate for the incorporation of such tools into clinical practice to prevent misdiagnoses and delays, particularly in complex post-COVID presentations. They also stress that a thorough evaluation of all imaging findings is necessary, as some COVID-associated complications can obscure or overlap with other serious conditions, including cancers.
Conclusions
This groundbreaking case highlights a hidden danger of COVID-19 that many physicians and patients may not be aware of: the potential for the virus to trigger severe, tuberculosis-like spinal infections. The case also emphasizes how post-COVID symptoms can mask more serious conditions, making timely diagnosis difficult. The reliance on conventional diagnostic methods alone may not be enough, and doctors should consider advanced imaging and molecular diagnostic tools in puzzling cases.
In this patient’s case, a combination of expert clinical suspicion, detailed imaging, and surgical intervention led to a life-saving diagnosis—not just of spinal osteomyelitis but also of early-stage lung cancer. It reinforces the need for vigilance in post-COVID care and encourages medical professionals to consider a wide differential diagnosis when symptoms persist. As more evidence emerges, it’s clear that the long-term effects of COVID-19 continue to surprise and challenge the global medical community.
The study findings were published in the peer-reviewed journal Cureus.
https://www.cureus.com/articles/350902-unmasking-the-hidden-culprit-diagnostic-challenges-in-thoracic-spinal-osteomyelitis-following-covid-19-infection#!/
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https://www.thailandmedical.news/news/covid-19-infections-can-lead-to-spinal-cord-injuries-and-myelopathies-with-initial-mri-findings-showing-atypical-presentations-at-onset
https://www.thailandmedical.news/news/sars-cov-2-detected-in-one-third-of-cerebrospinal-fluid-samples-of-those-exposed-to-covid-19
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