{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T21:01:24Z","timestamp":1763499684558,"version":"3.45.0"},"reference-count":9,"publisher":"CSIRO Publishing","issue":"2","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":1455,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,30]]},"abstract":"<jats:sec>\n                    <jats:title>INTRODUCTION<\/jats:title>\n                    <jats:p>Back and rib pain is a common presentation in primary care practice. Although most cases are secondary to non-specific musculoskeletal pain, it is essential for clinicians to identify patients presenting with life-threatening pathologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>AIM<\/jats:title>\n                    <jats:p>This case report serves as a reminder to clinicians to reconsider their initial diagnosis when a patient\u2019s pain fails to improve, while considering life-threatening pathologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CASE HISTORY<\/jats:title>\n                    <jats:p>We describe a 44-year-old man from India who presents to his general practitioner with a 2-week history of rib and upper back pain. He was initially diagnosed with non-specific musculoskeletal pain. However, after representing twice 2 months later due to persistent pain and due to the uncertainty about his condition, he was investigated with different imaging modalities. It was discovered on bone scan that he had osteolytic lesions in the right 11th rib and T2 vertebrae. As the cause of his osteolytic lesions were unclear, he was referred to different specialists. Skeletal tuberculosis was suspected when one of his specialists discovered his recent visit to India, a tuberculosis-endemic country. This reminded the specialist of the possible risks of the patient\u2019s background and its association with his symptoms. Bone biopsy of his lytic lesions revealed Mycobacterium tuberculosis, consistent with skeletal tuberculosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Revisiting the diagnosis of back and rib pain while considering other obscure and urgent pathologies is essential if a patient fails to improve clinically. Clinicians should focus on aspects of their clinical assessment to explore these pathologies, enabling earlier recognition of the disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/hc20027","type":"journal-article","created":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T08:07:45Z","timestamp":1622189265000},"page":"180-185","source":"Crossref","is-referenced-by-count":3,"title":["Chronic upper back and rib pain in a healthy man: re-examining the cause"],"prefix":"10.1071","volume":"13","author":[{"given":"Cai Jun Jean","family":"Liang","sequence":"first","affiliation":[{"name":"AThe University of New South Wales, Faculty of Medicine, NSW, Australia."},{"name":"DCorresponding author. Email: jeaninlcj@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George Wen-Gin","family":"Tang","sequence":"additional","affiliation":[{"name":"BThe University of New South Wales, Faculty of Medicine, School of Public Health and Community Medicine, NSW, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Herald","sequence":"additional","affiliation":[{"name":"CWaratah Private Hospital, Hurstville, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"67","published-online":{"date-parts":[[2021,5,28]]},"reference":[{"issue":"10070","key":"2025111814133792900_R1","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1016\/S0140-6736(16)30970-9","article-title":"Non-specific low back pain.","volume":"389","author":"Maher","year":"2017","journal-title":"Lancet."},{"issue":"2","key":"2025111814133792900_R2","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/j.mcna.2010.01.011","article-title":"An algorithm for the diagnosis and management of chest pain in primary care.","volume":"94","author":"Yelland","year":"2010","journal-title":"Med Clin North Am."},{"issue":"3","key":"2025111814133792900_R3","doi-asserted-by":"publisher","first-page":"305","DOI":"10.2522\/ptj.20140525","article-title":"Prevalence and \u201cRed Flags\u201d regarding specified causes of back pain in older adults presenting in general practice.","volume":"96","author":"Enthoven","year":"2016","journal-title":"Phys Ther."},{"issue":"9","key":"2025111814133792900_R4","doi-asserted-by":"publisher","first-page":"2788","DOI":"10.1007\/s00586-016-4684-0","article-title":"Red flags presented in current low back pain guidelines: a review.","volume":"25","author":"Verhagen","year":"2016","journal-title":"Eur Spine J."},{"issue":"4","key":"2025111814133792900_R5","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1093\/cid\/civ326","article-title":"Characteristics and clinical outcome of bone and joint tuberculosis from 1994 to 2011: a retrospective register-based study in Denmark.","volume":"61","author":"Johansen","year":"2015","journal-title":"Clin Infect Dis."},{"issue":"5","key":"2025111814133792900_R6","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1097\/00005792-199909000-00003","article-title":"Spinal tuberculosis in adults. A study of 103 cases in a developed country, 1980\u20131994.","volume":"78","author":"Pertuiset","year":"1999","journal-title":"Medicine (Baltimore)."},{"issue":"5","key":"2025111814133792900_R7","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1148\/rg.275065176","article-title":"Tuberculosis: a radiologic review.","volume":"27","author":"Burrill","year":"2007","journal-title":"Radiographics."},{"issue":"11","key":"2025111814133792900_R8","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.3928\/0147-7447-19981101-12","article-title":"Radiology of skeletal tuberculosis.","volume":"21","author":"Ridley","year":"1998","journal-title":"Orthopedics."},{"key":"2025111814133792900_R9","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1007\/s00586-012-2348-2","article-title":"Establishing the diagnosis of tuberculous vertebral osteomyelitis.","volume":"22","author":"Colmenero","year":"2013","journal-title":"Eur Spine J."}],"container-title":["The Journal of Primary Health Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/hc\/article-pdf\/13\/2\/180\/223189\/hc20027.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/hc\/article-pdf\/13\/2\/180\/223189\/hc20027.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T19:13:44Z","timestamp":1763493224000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/hc\/article\/13\/2\/180\/35005\/Chronic-upper-back-and-rib-pain-in-a-healthy-man"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,28]]},"references-count":9,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,5,28]]},"published-print":{"date-parts":[[2021,6,30]]}},"URL":"https:\/\/doi.org\/10.1071\/hc20027","relation":{},"ISSN":["1172-6156"],"issn-type":[{"type":"electronic","value":"1172-6156"}],"subject":[],"published":{"date-parts":[[2021,5,28]]}}}