A large tuberculosis abscess causing spinal cord compression of the cervico-thoracic region in a young child

Abstract

Introduction Despite numerous descriptive publications, the guidelines for treatment of cervical spinal tuberculosis (TB) are not very clear. The authors report a case of a young girl with cervico-thoracic spinal TB extending from C5 to T3 vertebrae presenting with weakness of the right hand and unsteady gait. Case report An 11-year-old female who is an immigrant to the UK from Afghanistan, presented to our clinic with a 10-day history of difficulty in walking with an unsteady gait and 3-month history of progressive weakness in both her arms, the right side more affected than the left. Her immunisation history was unclear. Examination of the arms showed bilateral thenar and hypothenar wasting, more so on the right than the left. An MRI scan revealed a large para-spinal abscess extending from C3/4 to T4/5 with a significant anterior epidural cord compression from C5/6 to

Tuberculous lumbar spinal epidural abscess in a young adult (case report)

“…The classical triad of fever, back pain and neurological deficits present in only 2% of the tubercular SEA [ 2 ]. Thoracic and lumbar region are the most commonly affected regions [ 4 ]. MRI is the diagnostic modality of choice.…”

“…Infection of the spine may lead to wide range of problems including the neurological deficit, mechanical instability, and deformity [ 3 ]. Very few isolated tubercular spinal epidural abscess have been reported [ 3 , 4 , 9 ] because most of the epidural abscesses are secondary to pyogenic infection [ 6 – 8 ]. Tubercular SEA usually develops secondary to involvement of vertebral body and rarely by hematogenous spread from a primary focus in the body [ 9 – 11 ].…”

Mielopatía compresiva por Mycobacterium tuberculosis en una niña de origen indígena: un caso clínico de zona endémica amazónica

“…La flecha blanca muestra la lesión compresiva con efecto de masa paravertebral a nivel de columna torácica. Percivall Pott en el siglo XVIII (9). Es relevante por mantenerse aún como causa de morbilidad y mortalidad, pues representa entre 1 y 2% de los 400 millones de casos de tuberculosis mundial (10,11).…”

“…Casos raros cursan con compromiso de columna cervical y se acompañan de dolor cervical y cifosis, siendo esta última una complicación tardía. El absceso puede extenderse hacia el espacio retro faríngeo y mediastino y comprometer la vía aérea con síndrome de dificultad respiratoria aguda y erosión arterial (9). Se puede observar alteración de la marcha o postura secundaria a presencia de espasmos musculares.…”

Expert’s comment concerning Grand Rounds case entitled “A large tuberculosis abscess causing spinal cord compression of the cervico-thoracic region in a young child” (by S. R. Manoharan, J. Leitao, P. Emberton and N. A. Quraishi, doi:10.1007/s00586-013-2729-1)

“…The authors present an interesting case of an 11-year-old female child with cervical spine epidural abscess of tuberculous origin with paraparesis of 3 months duration [1]. She was treated conservatively with oral antituberculous drugs, which led to complete resolution of the neurological symptoms and good radiological healing.…”