Tuberc Respir Dis.  2007 Oct;63(4):372-377.

A Case of Upper Thoracic Spinal Tuberculosis(T2-8) with T5,6 Compression Fracture in Pulmonary Tuberculosis Patient

Affiliations
  • 1Department of Chest Medicine, National Medical Center, Seoul, Korea. ps24k@freechal.com

Abstract

Tuberculous spondylitis is the most common manifestation of musculoskeletal tuberculosis (TB). The progression of the disease is usually slow and insidious. The main symptom, back pain, is not specific, which frequently results in a delayed diagnosis resulting in neurologic deficits and more advanced vertebral destruction. It is more difficult to diagnose the disease if the involved area is an uncommon sites, such as the upper thoracic, cervical or sacral region. It is important to make an early diagnosis and treatment to achieve a better treatment outcome. We reported a 29 year old female with upper thoracic TB spondylitis(T2-8) and pulmonary TB complaining of back pain that persisted for 5 months and fever. TB spondylitis was not suspected to be due to upper thoracic involvement despite her pulmonary tuberculosis. Chest CT for the evaluation of pulmonary TB found T5 destruction and the paravertebral abscess that was consistent with TB spondylitis. Her spine was examined by MRI, which made an early diagnosis before the neurologic deficit had developed. She was treated with surgical intervention due to the spinal instability and anti-TB medication for 1 year with excellent results.

Keyword

MRI; Upper thoracic TB spondylitis; Pulmonary tuberculosis

MeSH Terms

Abscess
Adult
Back Pain
Delayed Diagnosis
Early Diagnosis
Female
Fever
Fractures, Compression*
Humans
Magnetic Resonance Imaging
Neurologic Manifestations
Sacrococcygeal Region
Spine
Spondylitis
Tomography, X-Ray Computed
Treatment Outcome
Tuberculosis
Tuberculosis, Pulmonary*

Figure

  • Figure 1 Plain chest radiograph taken on admission shows increased infiltrative density on left lung.

  • Figure 2 Chest CT scan shows destruction of T5 vertebral body and paravertebral abscess.

  • Figure 3 Spine MRI (left: T2 weighted image, right: T1 weighted image) shows compression fracture, fusion and kyphotic deformity of T5 and T6 and paravertebral abscess.

  • Figure 4 Surgical biopsy shows chronic acitive osteomyelitis with suspicious granulomatous lesion (H&E, ×200).

  • Figure 5 Plain chest radiograph taken after completion of anti-TB therapy for 12 months.


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