Images in Clinical Medicine
Vertebral Tuberculosis
N Engl J Med 1998; 338:1677June 4, 1998
- Article
Figure 1 A 62-year-old man presented to the hospital with an inability to walk unaided. He had noticed progressive weakness of his legs over the previous two weeks and had a three-month history of thoracic back pain, night sweats, and a weight loss of 10 kg. He had no history of tuberculosis. On examination, the patient was afebrile, had bilateral cervical and axillary lymphadenopathy, and had a tender kyphotic deformity of the midthoracic spine. There was increased muscular tone and brisk deep-tendon reflexes in both legs; the plantar reflexes were flexor. Sensitivity to pinprick and light touch was reduced below T8. Radiographs of the chest showed collapse of the seventh onto the eighth thoracic vertebra and clear lung fields. T1-weighted magnetic resonance imaging of the thoracic spine confirmed the vertebral collapse and revealed associated spinal cord compression and a large paravertebral mass that extended from T6 to T9. The patient was treated with dexamethasone and underwent surgical decompression of the spinal cord, débridement of a paravertebral abscess, and fixation of the seventh and eighth thoracic vertebrae by autologous bone graft. Histologic examination of specimens taken at operation revealed necrotic tissue with a chronic inflammatory-cell infiltrate and numerous caseating granulomata. Acid-fast bacilli were not seen on Ziehl–Neelsen staining of the surgical material, but Mycobacterium tuberculosis was grown after 12 weeks of incubation, confirming the diagnosis of vertebral tuberculosis. The patient was treated with streptomycin for 1 month, pyrazinamide for 3 months, and isoniazid and rifampin for 15 months. On examination at 15 months he had mild residual kyphosis of the thoracic spine but was otherwise well.
Peter J. Jenks, M.D.
Pasteur Institute, 75724 Paris, FranceBruce Stewart, M.D.
Royal London Hospital, London E17BE, United Kingdom- Citing Articles (1)
Citing Articles
1
Christiana Savvidou, Charikleia Triantopoulou, Sofia N. Chatziioannou, John Papailiou, Dimitrios S. Korres, Spiros G. Pneumaticos. (2010) A rare radiological appearance of lumbar tuberculous vertebral osteomyelitis. European Journal of Orthopaedic Surgery & Traumatology 20:4, 313-316
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