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

Abstract

Introduction: Spinal Epidural abscess (SEA) is an uncommon pathology that needs an urgent intervention to decompress the pressure on the spinal epidural sac, cord, and roots. The authors report a rare case of a young adult with lumbar spinal epidural tuberculous abscess occupying the spinal canal from L2–L5 vertebrae with extesion to the posterior paraspinal muscles and presenting with bilateral progressive lower limb weakness. Case report: A 42 years old male teacher presented with a 15-day history of progressive difficulty to walking and bilateral lower limb weakness associated with fever, malaise and later on urinary incontinence. A magnetic resonance imaging (MRI) scan revealed a paraspinal intermuscular abscess and an abscess occupying the spinal canal compressing the dural sac from L2–L4/5, without any signs of vertebral involvement. Surgery was done by a posterior midline incision. Pus was evacuated from multiple pockets through the paraspinal muscle layers. Laminectomy for L3/4, and hemilaminectomy for L2/3, and L4/5 were performed. Pus and bone specimens were negative for acid-fast bacilli. However, both histopathological studies and Polymerase Chain Reaction (PCR) testing confirmed the presence of tuberculosis (TB). The patient received TB antibiotics, and a follow-up MRI scan at 2 months showed complete evacuation of the abscess. However, signs of L5 spondylitis were evident. No further surgery was needed as there was no vertebral collapse or neural compression and the patient's clinical condition was improving. He had normal right lower limb power and sensation and grade 4+ motor power of the left lower limb. Bowels and bladder function was normal.Conclusion: Isolated tuberculous spinal epidural abscess is a rare disease and should be treated urgently with evacuation and decompression. Signs of spondylitis or spondylodiscitis may appear later and therefore long follow up is recommended in tuberculous cases presenting with an isolated epidural abscess.

A rare case of disseminated tuberculosis presenting as multiple visceral abscesses: retropharyngeal abscess, epidural abscess, pulmonary Koch’s, hepatic granuloma and splenic abscess

“…MRI examination, tissue culture and biopsy can confirm diagnosis. 3,18 Our patient had fever, neck pain and stiffness but no neurological deficit, CECT head revealed an epidural abscess of 4cc posterior to the body of vertebra extending superiorly from the clivus to inferiorly till the superior border of C7 vertebra.…”

Magnetic resonance imaging of spinal epidural lesions

“…Around 2% of the spinal epidural abscess is contributed by tuberculosis. [ 12 ] Also known as ‘Pott’s disease’, tuberculous spondylitis represents the most common form of extrapulmonary tuberculosis. It often involves two or more contiguous vertebral bodies, with spread of infection to other vertebral levels deep to the longitudinal ligaments.…”

Rare huge cold abscess and paraplegia in a young man with multidrug-resistant spinal tuberculosis

“…Infectious TB remains a serious challenge for developing countries. Young people whose resistance declined due to irregularities in their daily routine and diet are at a high risk of contracting mycobacterium TB (3). Once the drug is not taken regularly according to the protocol after infection and has progressed to multidrug-resistant spinal TB, treatment become more difficult.…”