Correspondence

Correction

Tuberculosis and Pott's Disease

N Engl J Med 2003; 348:1501April 10, 2003

Article

To the Editor:

Although the clinical history and images of tuberculosis with Pott's disease presented by Weber and Scherübl (Dec. 5 issue)1 were instructive, I believe their reference to the Langerhans' cell was incorrect. The characteristic cell of the tuberculous granuloma is the Langhans' giant cell. The Langerhans' giant cell refers to the dendritic antigen-processing cell of the Langerhans' cell granulomatoses, formerly known as eosinophilic granulomas. Students of pathology may find it helpful to recall the “e” in both Langerhans and eosinophilic granuloma.

Vincent J. Vigorita, M.D.
Lutheran Medical Center, Brooklyn, NY 11220
vvigorita@lmcmc.com

1 References

1. 1

   Weber U, Scherubl H. Tuberculosis with atlantoaxial and craniovertebral Pott's disease. N Engl J Med 2002;347:1849-1849
   Full Text | Web of Science | Medline

To the Editor:

Weber and Scherübl present an excellent computed tomographic image of changes in the upper cervical spine in a patient with tuberculosis and Pott's disease. However, we disagree with the authors that the scan shows lateral subluxation of the dens axis as the result of a fracture of the left lateral atlas. Our opinion is that the scan shows lateral subluxation of the atlas; the dens axis is still in the right place above the rest of the body. True lateral subluxation of the dens axis would need a fracture in the dens or other pathologic processes in the axis, which the authors do not mention. Furthermore, lateral subluxation of the dens axis cannot be the result of a fracture in the atlas.

Kari Laiho, M.D.
Markku Kauppi, M.D., Ph.D.
Irma Soini, M.D., Ph.D.
Rheumatism Foundation Hospital, FIN-18120 Heinola, Finland

Author/Editor Response

We thank Dr. Vigorita for correctly pointing out that our patient had caseating granulomas containing not only acid-fast bacilli but also the characteristic Langhans' giant cells. We agree with Dr. Laiho and colleagues that the dens axis was not fractured. However, the left massa lateralis atlantis was destroyed (Figure 1Figure 1Computed Tomographic Scan Showing Destruction of the Left Massa Lateralis Atlantis (Arrows).). No doubt there was subluxation of both C0–C1 and C1–C2.

Hans Scherübl, M.D.
Ulrich Weber, M.D.
Free University of Berlin, D-12200 Berlin, Germany

Citing Articles (2)

Citing Articles

1. 1

   B. Sierra-Bergua, M. Sanchez-Marteles, J.L. Morales-Rull, S. Letona-Carbajo, I. Sanjoaquin-Conde. (2010) Dolor cervical y astenia: tuberculosis de una localización inusual. Revista Clínica Española 210:8, e33-e35
   CrossRef

2. 2

   Tu-Sheng Lee, Yu-Min Lin. (2006) Langhans’ giant cell or Langerhans’ giant cell?. Respiratory Medicine 100:9, 1666
   CrossRef