Korean J Nephrol.  2001 Nov;20(6):1075-1079.

Tuberculous Spondylitis in a Hemodialysis Patient

• You HY
• Shin YS
• Woo YS
• Che GH
• Lee JR
• Lee SY
• Park CW
• Ahn MI
• Chang HS
• Bang BK

Abstract

Patients undergoing maintenance dialysis show an increased susceptibility to tuberculosis because host immunity is decreased secondary to malnutrition, impaired cellular immunity, acidosis and etc. Extrapulmonary tuberculosis is more prevalent in patients with end stage renal disease than in normal subjects. Among the extrapulmonary tuberculosis in patients receiving hemodialysis, the diagnosis of tuberculous spondylitis is difficult because the symptoms are non specific and attributable to uremia, and the appearance of plain radiographs is often normal during the early phase of the disease. We experienced a case of tuberculous spondylitis in a hemodialysis patient. A 55 years old female admitted with fever, weight loss and back pain. Conventional radiograph of T-spine showed no definite abnormal finding. However, chest CT revealed heterogeneously enhancing soft tissue around the T8 vertebral body and T-spine MRI showed compatible finding to tuberculous spondylitis. She received radical excision of involved vertebra and confirmed tuberculous spondylitis with histologic finding from a surgical specimen. Following the administration of anti-tuberculosis medication(isoniazid, rifampin, pyraziamide, ethambutol) and radical excision, patient's symptom and sign were improved. The patient is maintaining dialysis with anti-tuberculosis medication for 5 months.

Keyword

End stage renal disease; Tuberculous spondylitis; Anti Tuberculosis medication; Radical excision surgery

MeSH Terms

Acidosis
Back Pain
Diagnosis
Dialysis
Female
Fever
Humans
Immunity, Cellular
Kidney Failure, Chronic
Magnetic Resonance Imaging
Malnutrition
Middle Aged
Renal Dialysis*
Rifampin
Spine
Spondylitis*
Tomography, X-Ray Computed
Tuberculosis
Uremia
Weight Loss
Rifampin