Skip to main content Skip to main navigation menu Skip to site footer

A tuberculosis spondylitis patient with paraplegic manifestations

  • Nugra Akzatama ,
  • Lita Diah Rahmawati ,

Abstract

Background: Mycobacterium tuberculosis is the primary causative agent of tuberculous spondylitis (TB spondylitis), a chronic granulomatous inflammatory disease of the spine. Patients with TB spondylitis may have spinal lesions in up to 50% of cases, and 10-45% may also have neurological deficits. We reported a case of severe paraplegia manifesting TB spondylitis in a young adult patient.

Case Presentation: A 28-year-old female Javanese Muslim was admitted to Dr. Soetomo General Academic Hospital in Surabaya, Indonesia with back pain, inability to move, and feeling stiff in both legs. During previous therapy, the patient was thought to have spondyloarthropathy. X-ray examination demonstrated T9 to T10 retrolisthesis and T10 corpus lipping. Thoracolumbosacral MRI with contrast revealed that the patient had TB spondylitis. A debridement and hemilaminectomy of T7-8 for fusion with bone segments at T7-8 were performed on the patient. The patient was treated with oral antituberculosis drugs for 10 months and could walk perfectly 8.5 months after the initial treatment.

Conclusion: This case demonstrates the complexities of diagnosing TB spondylitis, which necessitates the use of multiple disciplines. Because the clinical manifestations of TB spondylitis differ, various methods, including thoracolumbosacral X-ray and MRI with contrast, are required to confirm the disease. As a result, an interdisciplinary collaborative team is required to achieve optimal patient outcomes and to prevent long-term sequalae.

References

  1. Garg RK, Somvanshi DS. Spinal tuberculosis: a review. J Spinal Cord Med. 2011;34(5):440-54.
  2. Yanti B, Hadi S, Harrika F, Shehzad A. Giant bronchopleural fistula and empyema in a tuberculosis patient with diabetes mellitus: Vista from a high tuberculosis burden country in Southeast Asia. Narra J. 2022;2(2):1-6.
  3. Noerhalimah T. The Scope Of PHBS In Household And Healthy Home With The Incidence Of Tuberculosis In West Java. Journal of Public Health Research and Community Health Development. 2020;4(1):28-42.
  4. Winardi W, Wahyuni H, Hidayat M, Wirawan A, Uddin MN, Yusup M. Challenges on tuberculosis care in health care facilities during COVID-19 pandemic: Indonesian perspective. Narra J. 2022;2(2):e80.
  5. Rajasekaran S, Soundararajan DCR, Shetty AP, Kanna RM. Spinal tuberculosis: current concepts. Global Spine Journal. 2018;8(4_suppl):96S-108S.
  6. Wang D. Diagnosis of tuberculous vertebral osteomyelitis (TVO) in a developed country and literature review. Spinal Cord. 2005;43(9):531–42.
  7. Kusmiati T, Narendrani H. POTT’S Disease. Respiratory Journal. 2016;2(3):99-109.
  8. Moon MS. Tuberculosis of spine: current views in diagnosis and management. Asian Spine J. 2014;8(1):97-111.
  9. Destiansyah RA, Subagio EA, Bajamal AH, Faris M. One-stage anterior approach for long-segment subaxial cervical spondylitis tuberculosis: A case report. Int J Surg Case Rep. 2022;99:107693.
  10. Kalanjati VP, Oktariza RT, Yahya Y, Machin A. Paralytic ileus in the patient with tuberculosis of spine. British Journal of Neurosurgery 2020;34(6):602-3.
  11. Kusmiati T, Narendrani HP. Pott’s Disease. Jurnal Respirasi 2016;2(3):99-109.
  12. Tsantes AG, Papadopoulos DV, Vrioni G, Sioutis S, Sapkas G, Benzakour A, Benzakour T, Angelini A, Ruggieri P, Mavrogenis AF, World Association Against Infection In Orthopedics And Trauma W A I O T Study Group On Bone And Joint Infection Definitions. Spinal Infections: An Update. Microorganisms. 2020;8(4):1-18.
  13. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Jr., Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7): 478-91.
  14. Esteves S, Catarino I, Lopes D, Sousa C. Spinal tuberculosis: rethinking an old disease. J Spine. 2017;6(1):358-366.
  15. Tuli SM. Historical aspects of Pott's disease (spinal tuberculosis) management. Eur Spine J. 2013;22 Suppl 4(Suppl 4):529-38.
  16. Milligan J, Ryan K, Lee J. Demystifying spasticity in primary care. Canadian Family Physician. 2019;65(10):697-703.
  17. Chaudhary R, Bhatta S, Singh A, Pradhan M, Shrivastava B, Singh YI, et al. Diagnostic performance of GeneXpert MTB/RIF assay compared to conventional Mycobacterium tuberculosis culture for diagnosis of pulmonary and extrapulmonary tuberculosis, Nepal. Narra J. 2021;1(2):e33.
  18. Lacerda C, Linhas R, Duarte R. Tuberculous Spondylitis: A Report of Different Clinical Scenarios and Literature Update. Case Rep Med. 2017;2017:4165301.
  19. World Health Organization (WHO), Initiative ST. Treatment of tuberculosis: guidelines: World Health Organization; 2010.
  20. Kizilbash QF, Seaworth BJ. Multi-drug resistant tuberculous spondylitis: A review of the literature. Ann Thorac Med. 2016;11(4):233-236.
  21. Oguz E, Sehirlioglu A, Altinmakas M, Ozturk C, Komurcu M, Solakoglu C, et al. A new classification and guide for surgical treatment of spinal tuberculosis. International orthopaedics. 2008;32(1):127-33.

How to Cite

Akzatama, N., & Rahmawati, L. D. . (2023). A tuberculosis spondylitis patient with paraplegic manifestations. Bali Medical Journal, 12(1), 888–892. https://doi.org/10.15562/bmj.v12i1.4062

HTML
6

Total
8

Share

Search Panel

Nugra Akzatama
Google Scholar
Pubmed
BMJ Journal


Lita Diah Rahmawati
Google Scholar
Pubmed
BMJ Journal