25th February 2025

A 55-year-old lady presents to A&E with perianal numbness and reduced mobility and sensation in both legs.

A 55-year-old lady presents to A&E with perianal numbness and reduced mobility and sensation in both legs. She notes chronically worsening back pain, which can wake her up at night, along with weight loss and fatigue. She grew up abroad and works long hours as a cleaner. She is recently in remission for breast cancer. On examination, you confirm neurological findings but also find evidence of infected eczema. MRI shows spinal cord compression and infiltration of L2. Bone biopsy shows caseating granulomas and joint destruction. What is the likely cause?

Select the SINGLE most appropriate option from the list below. Select ONE option only.