Gustavo A. Correspondence to: Dr. Hospital Regional de Alta Especialidad Dr. Email: moc. Received Sep 29; Accepted Nov 8. Copyright Quantitative Imaging in Medicine and Surgery.
|Published (Last):||19 November 2017|
|PDF File Size:||3.69 Mb|
|ePub File Size:||6.48 Mb|
|Price:||Free* [*Free Regsitration Required]|
Gustavo A. Correspondence to: Dr. Hospital Regional de Alta Especialidad Dr. Email: moc. Received Sep 29; Accepted Nov 8. Copyright Quantitative Imaging in Medicine and Surgery. All rights reserved. This article has been cited by other articles in PMC. It is the most common granulomatous disease of the spine, which is characterized by being chronic and slowly progressive, to its confirmation Mycobacterium tuberculosis isolation or identification of granulomas in a sample obtained from the injured vertebrae is needed 2 , 3.
Imaging studies are important for diseases detection, mainly the computed axial tomography CT and magnetic resonance imaging MRI which since have made it possible to detect the disease at a predestructive phase and at rare sites of presentation 1 , 2.
Treatment involves the use of antituberculosis drugs for at least 6 months, and surgery was reserved for cases with progressive deformity or neurological deficit in which medical treatment is not effective, which represents one-third of patients 1 , 3 , 4. In the search made in PubMed database there were scarce cases with the same characteristics 5 , 6.
In this report we represent two cases of tuberculous spondylodiscitis. He started symptoms 2 months before the admission at the clinics with pleuritic pain in the posterior thorax, which was intensified with deep breathing, partially decreasing with the administration of NSAIDs acetaminifen and diclofenac , adding paresthesia and dysesthesia in the left lower limb.
Subsequently he presented morning fever quantified up to In the physical examination, decreased muscle strength and tendon reflexes of lower limbs, and sensory level in T6 dermatome were found. Paraclinical on admission: Hb: Chest X-ray result within normal parameters.
CT of chest was performed, in which an image hypodense paravertebral between T2—T5 was observed, as well as a destruction of the vertebral bodies of T5 and T6 Figure 1. Was requested thoracic spine MRI, finding mediastinal tumor involving vertebral bodies T4—T5, with spinal cord compression, in T2 an isointense, paravertebral and bilateral image was observed at T2—T5 level, suggestive of abscess, as well as fracture and collapse of the vertebral body of T5 Figure 1.
Biopsy was performed reporting chronic granulomatous inflammatory lesions with multinucleated giant cells with caseous necrosis without cellular atypia. Ziehl-Neelsen stain was made finding scarce acid-fast bacilli compatible with Mycobacterium tuberculosis. It was valued by the spinal surgery department that suggested conservative management with permanent Jewett corset till control infection. Management with Dotbal rifampin, isoniazid, pyrazinamide, ethambutol , two tablets every 12 hours began, completing intensive and supportive phase.
The treatment was successful, currently he presents results of the polymerase chain reaction PCR for Mycobacterium tuberculosis negative and sensory and motor recovery of the limbs, normal tendon reflexes, he performs physical effort without complications, without the presence of chest pain and also he has remained afebrile.
ESPONDILODISCITIS TUBERCULOSA PDF
Espondilodiscitis tuberculosa Images in clinical medicine. Diagnosis by images of vertebral tuberculosis. Published studies are primarily clinical and epidemiological research but also basic. Abscess drainage was performed with Ziehl-Neelsen stain, where acid-fast bacilli were compatibles with Mycobacterium tuberculosis were observed, confirming the diagnosis with culture. A Skull tomography in axial section, in which hypodense image is observed with jagged edges at right parietal lobe level; B skull tomography with contrast in coronal section, in which the presence of a hypodense image emphasizing in ring at right parietal lobe, with subfalcial hernia and compression of right lateral ventricle is observed; C skull tomography with contrast in sagittal section, where the presence of a hypodense image emphasizing in ring at right parietal lobe, surrounded by a hypodense image, suggestive edema is observed; D skull tomography with contrast in axial section, where the presence of a hypodense image emphasizing in ring at right parietal lobe level, with midline shift to the left is observed.
Los pacientes afectados de procesos que comportan una elevada incidencia de bacteriemia, en especial la endocarditis y las infecciones urinarias, tienen un riesgo especial de sufrir una espondilodiscitis. La coexistencia con otras formas, pulmonares o extrapulmonares, de tuberculosis activa es rara. Con menor frecuencia se observa en pacientes inmunodeprimidos sometidos a antibioterapia de amplio espectro o a cateterizaciones prolongadas. Especialmente en la espondilodiscitis brucelar, puede observarse la presencia de una epifisitis marginal. Tiene el inconveniente de la falta de especificidad. El valor de su positividad no debe magnificarse, en especial en pacientes de edad avanzada.
Espondilodiscitis tuberculosa. Caso 475
Two cases of tuberculous spondylodiscitis: a rare manifestation of extrapulmonary tuberculosis