Tubercular spinal epidural abscess involving the dorsal-lumbar-sacral region without osseous involvement

Arora, Sumit; Kumar, Ramesh

doi:10.3855/jidc.1494

Cited by 22 publications

(13 citation statements)

References 14 publications

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“…A literature review of Mycobacterium causing an epidural collection discloses a number of studies reporting both typical ( M. tuberculosis, M. bovis, and M. leprae ) and atypical ( M. abscessus, M. avium-intracellulare, and M. fortuitum ) Mycobacterium causing epidural abscesses. In some cases, the epidural abscess extended into neighboring bone, intervertebral disc, and paraspinal and psoas musculature [ 10 , 13 , 14 ], while in others, adjacent osseous and soft tissue structures were not reported to be involved [ 15 - 17 ]. As mentioned in Introduction, only one other case of an isolated M. abscessus epidural abscess has been reported.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Osteomyelitis Caused by Mycobacterium abscessus Necessitating Surgical Decompression and Revision Surgery With Interbody Fusion

Bashti¹,

Kumar²,

Côté³

et al. 2023

Cureus

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Epidural abscesses can be caused by a number of different organisms, including atypical Mycobacterium. This is a rare case report of an atypical Mycobacterium epidural abscess requiring surgical decompression. Here, we present Mycobacterium abscessus causing a nonpurulent epidural collection surgically treated with laminectomy and washout and discuss clinical clues and radiologic characteristics associated with this condition.A 51-year-old male with a past medical history of chronic intravenous (IV) drug use presented with a threeday history of falls and three-month history of progressively worsening bilateral lower extremity radiculopathy, paresthesias, and numbness. MRI demonstrated an enhancing collection at L2-3 ventral and to the left of the spinal canal causing severe compression of the thecal sac, along with heterogenous contrast enhancement of the L2-3 vertebral bodies and intervertebral disc. The patient was taken for an L2-3 laminectomy and left medial facetectomy, where a fibrous, nonpurulent mass was discovered. Cultures ultimately demonstrated Mycobacterium abscessus subspecies massiliense, and the patient was discharged on IV levofloxacin, azithromycin, and linezolid with complete symptomatic relief.Unfortunately, despite surgical washout and antibiotic coverage, the patient presented twice more, the first time with a recurrent epidural collection requiring repeat drainage and the second time with a recurrent epidural collection with discitis and osteomyelitis with pars fractures requiring repeat epidural drainage and interbody fusion.It is important to recognize that atypical Mycobacterium abscessus can cause a nonpurulent epidural collection, especially in high-risk patients such as those with a history of chronic IV drug use. Additionally, our initial intraoperative findings of a fibrous, adherent mass suggest that in cases where this entity is suspected, surgical decompression should be carefully considered. To this end, the radiologic findings associated with this condition, namely, an enhancing ventral epidural mass involving the disc space, should also be recognized. The notable postoperative course consisting of recurrent collections and osteomyelitis with a pars fracture suggests that early fusion should be considered as an option in these patients. This case report presents clinical and radiologic findings associated with an atypical Mycobacterium discitis and osteomyelitis. The clinical course described herein suggests that early fusion in these patients may provide superior results to decompression alone.

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Section: Discussionmentioning

confidence: 99%

Recurrent Osteomyelitis Caused by Mycobacterium abscessus Necessitating Surgical Decompression and Revision Surgery With Interbody Fusion

Bashti¹,

Kumar²,

Côté³

et al. 2023

Cureus

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“…Marrow edema, preservation of disc space, subligamentous extension of abscess, paravertebral abscess, epidural extension, endplate erosions and discitis were consistently observed in 83% cases of spine tuberclusis on MRI [75]. If pus exists, the diagnosis may be confirmed by histopathological demonstration of Mycobacterium tuberculosis in drained pus [76]. CT-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis [24].…”

Section: Tuberculosismentioning

confidence: 99%

Paraplegia Caused by Infectious Agents; Etiology, Diagnosis and Management

Abbasi¹,

Fardkhani²

2014

Topics in Paraplegia

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“…Spinal TB, one type of EPTB, is one of the most common and serious forms of TB lesions and accounts for 1-3% of all TB cases 2 . The incidence of spinal TB has been increasing 3 , probably as a consequence of aging populations, easy access to better diagnostics and an increased number of immunocompromised hosts 4 . Sequelae happen in 47.5% of spinal TB patients, and the mortality rate is 8.6% 5 .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy evaluation of the conventional and molecular tests for Spinal Tuberculosis in a cohort, head-to-head study

Wang

Dong

Lan

et al. 2018

Emerging Microbes & Infections

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Early diagnosis of spinal tuberculosis (TB) is hampered by the flaws of conventional tests. The aim of this study was to assess the value of new and existing molecular tests in a prospective, head-to-head cohort study. Specimens were consecutively collected from spinal TB suspects in four hospitals in Beijing, China. Smear, culture, histopathology, Xpert MTB/RIF (Xpert), and MeltPro TB assays were performed in parallel using the same specimen from each patient. Drug-susceptibility testing (DST) was conducted on the isolates recovered. In total, 438 suspects were recruited; 319 of them were diagnosed with spinal TB according to the composite reference standard (CRS), which was composed of clinical, laboratory, histopathological, and radiological examinations and 18 months of follow-up. Based on conventional testing, 74.29% of patients were classified as confirmed cases, which increased to 90.6% when Xpert outcomes were integrated. Further, 76.60% of probable and 45.71% of possible cases were re-classified as confirmed cases with Xpert. Xpert (85.27%) produced higher sensitivity than histopathology (73.04%), MeltPro TB (57.68%), culture (51.72%) and smear (24.45%) (all P <0.001). Xpert was 100% concordant with phenotypic DST regarding rifampicin resistance detection. The sensitivity and specificity of MeltPro TB for rifampicin resistance detection were 100% and 97.96%, respectively, and 95.00% and 93.88% for isoniazid resistance detection. New molecular tests demonstrated excellent efficiency for spinal TB diagnosis in this cohort study, so their application as initial diagnostic tools would greatly increase the proportion of confirmed cases and dramatically reduce the delay of appropriate treatment. An updated laboratory testing algorithm of the disease is desirable.

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Tubercular spinal epidural abscess involving the dorsal-lumbar-sacral region without osseous involvement

Cited by 22 publications

References 14 publications

Recurrent Osteomyelitis Caused by Mycobacterium abscessus Necessitating Surgical Decompression and Revision Surgery With Interbody Fusion

Recurrent Osteomyelitis Caused by Mycobacterium abscessus Necessitating Surgical Decompression and Revision Surgery With Interbody Fusion

Paraplegia Caused by Infectious Agents; Etiology, Diagnosis and Management

Diagnostic accuracy evaluation of the conventional and molecular tests for Spinal Tuberculosis in a cohort, head-to-head study

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