A Case of Cervical Spine Tuberculosis in an Infant

Abstract

An eight-month-old male infant was brought to paediatric department of our hospital with history of fever since 13 days, projectile vomiting since 07 days and drowsiness since 03 days. The fever was of moderate degree and intermittent type, which was followed by projectile vomiting and later the child became drowsy with poor feeding. The child was born out of non consanguineous marriage and had attained all the milestones at the expected rate. The birth of the child was uneventful and was a full term institutional delivery. The child was inoculated with Bacillus Calmette-Guerin (BCG) in neonatal period which was followed by normal reaction and scar.On examination the child was drowsy but arousable with a heart rate of 120 bpm, blood pressure of 100/70 mm of Hg, respiratory rate of 24 and temperature of 100 degree F. The child weighed 7.5 kgs. The head circumference measured normal for age. The anterior fontanelle was tense, and bulging. Bilateral pupils were equally reactive. Neck rigidity was present with occasional tonic flexion in the upper limbs. The deep tendon jerks were exaggerated bilaterally with bilateral extensor plantar reflex. The neck movements were painful and restricted. There was no lymphadenopathy, papilloedema, muscle wasting or weakness. Fig-2] showed gross dilatation of the ventricular system (lateral, third and fourth) with obliteration of the sulci and cisterns. The VSI (Ventricular size index) was 53% with the frontal horn forming an acute angle with the midline septum. There was thickening and intense enhancement of the dura predominantly in the basal region [Table /Fig-3]. The cerebral white and gray matter showed normal morphology and signal intensity. MRI of cervical spine showed collapsed body of CV5 with enhancing soft tissue component which was seen tracking into the extradural space causing significant indentation of the anterior thecal space [Table / Fig-4]. There was associated intense leptomeningeal enhancement around the spinal cord which was extending intracranially.Based on the clinical, laboratory and imaging findings, a provisional diagnosis of spinal tuberculosis with TBM was made. Image guided tissue sampling from the paravertebral soft tissues was perceived as dangerous by the parents and consent for the same was denied. aBstRaCtTuberculosis of cervical spine is an extremely rare entity in infants with only few case reports available in the literature. The diagnosis is often delayed due to less dramatic effects of paraplegia or quadriplegia in an infant as compared to older paediatric population. Along with clinical and laboratory investigations, imaging plays a crucial role in defining the extent of involvement, evaluation of complications, providing suitable differential diagnosis and monitoring response to treatment. Tuberculosis typically involves the discovertebral complex while involvement of isolated vertebral body or multiple vertebrae without involving the intervertebral discs is much less common. We present such an unusual case of cervical spine tuberculosi...

Tuberculosis Spine in Neonate: A Case Report

“…Almost 3% of children with spine TB develops severe kyphosis of more than 60° [5]. Factors increasing the risk of severe kyphotic deformity are children being below 10 years of age, involvement of three or more vertebral bodies and localization of the lesion in the thoracic spine [3,7,8] as presented in our case. Therefore, long term follows up for this patient is mandatory.…”

“…The overall incidence of vertebral osteomyelitis is 1 in every 250 000. The estimated prevalence among the children is however not available due to limited data and literature [3,4]. At the later stage of TB spine patients might also presented with sensory disturbance, bowel and bladder dysfunction.…”

“…In TB spine, the upper and lower thoracic spine are the most commonly involved sites whereas in vertebrae osteomyelitis, lumbar sacral is found as the most affected site which accounts 75% out of all pyogenic spondylitis. In most cases of Tb spine, more than one vertebra is usually affected [3]. One of our challenge in this case was to differentiate spinal TB from pyogenic and fungal vertebral osteomyelitis as well as primary and metastatic spinal tumours because only clinical and radiographic findings are available.…”

“…At this stage, the disease is often at a very advanced stage with patients having neurological presentations. Common characteristic radiographic findings on x-rays include rarefaction of the vertebral end plates, loss of disk height, osseous destruction, new-bone formation and soft-tissue abscess [2,3]. Often, multiple vertebrae are involved and late fusion or collapse of vertebrae is not uncommon.…”

“…About 10 % of patient with extra pulmonary TB have skeletal involvement and spine TB accounts for 50% out of this number followed by hip and knee [2]. Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurological deficit due to compression of the adjacent neural structures and significant spinal deformity [3]. Therefore, early detection of spine TB is very crucial.…”