Life-threatening disseminated tuberculosis masquerading as cervical spondylosis---Case report “Cervical TB v/s Cervical Spondylosis”

Abstract

Tuberculosis (TB) is quite prevalent in developing countries, with an ever-rising incidence of extrapulmonary cases. TB of bones and joints is quite challenging to diagnose. Most spinal TB lesions localize at the thoracic and lumbar levels; cervical lesions are a rarity. Hence, most neck pains are labelled cervical spondylosis as the symptomatology of cervical spine tuberculosis (CTB) remains unclear. A 38-year-old male had long-standing neck pain for six months, not associated with any focal neurological deficit, nausea, vomiting, or blurred vision. After the initial evaluation by local practitioners, the pain was, as usual, attributed to cervical spondylosis and conservatively managed. However, his pain worsened, and he ultimately came to us with altered mental status. In reality, he had CTB, which later complicated to life-threatening disseminated TB with intracranial and pulmonary involvement, and he could only survive after prolonged ICU care. Even mild cervical pain should not be neglected and must undergo proper evaluation. We should consider CTB in the differential diagnosis of chronic neck pain, especially in countries where TB is endemic.