Multifocal Extensive Spinal Tuberculosis Accompanying Isolated Involvement of Posterior Elements: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of atypical spinal tuberculosis. SUMMARY OF LITERATURE REVIEW: In spinal tuberculosis, non-contiguous multifocal involvement and isolated involvement of posterior elements of the spine have been considered atypical features. There have been a few reports of each of these atypical features but no reports have described spinal tuberculosis with both of these atypical features. MATERIALS AND METHODS: A 39-year-old man presented with back pain and progressive weakness of both lower extremities. He was diagnosed with spinal tuberculosis from the cervical to sacral spine, showing multifocal non-contiguous involvement with multiple abscesses on magnetic resonance imaging. Notably, in the thoracic spine area, isolated involvement of posterior elements was found with an epidural abscess compressing the spinal cord. He underwent a total laminectomy of the thoracic spine and multiple abscesses were drained with pigtail catheter insertions into the cervical, thoracic, and lumbar spine. RESULTS: At the 8-month follow-up, the patient's neurologic status had improved to Frankel Grade D, and the patient was able to walk with the support of a walker. At the 3-year follow-up, the patient had recovered completely without any neurologic deficit. CONCLUSIONS: Since atypical spinal tuberculosis may show various patterns, examination of the entire spine is important for early diagnosis. Treatment should be provided properly from minimally invasive procedures to open surgery depending on the extent of structural instability and neurologic deficit.

Primary laryngeal tuberculosis: a rare cause of chronic laryngitis.

Tuberculosis (TB) is not only a major public health problem of developing countries like India, since its incidence is increasing due to increasing immune-depressive states including HIV, malignancies and cytotoxic chemotherapy. Laryngeal TB occurs usually a secondary to associate with pulmonary disease, and primary form is very rare in immune-competent people. We report a 49‑years‑old non-smoker, non-diabetic, immunocompetent man presenting with chronic dry cough and hoarseness without any constitutional symptoms, family or contact history of TB. The chest X-ray was normal. Laryngoscopy showed congested larynx without any ulcer or mass and normal vocal cords. Biopsy from aryepiglottic fold was suggestive of TB, but caseation was absent. Diagnosed to be primary laryngeal TB, he responded well to anti-tubercular therapy. Primary laryngeal TB without pulmonary TB can mimick chronic laryngitis. Before anti-tubercular drug use, in the 1950’s, it was a common and frequently fatal disease but it’s clinical features, age group involved and prognosis has changed over the last few decades. It is more infectious than pulmonary form primarily due to delayed diagnosis. It can mimick a common condition like chronic laryngitis, although different macroscopic lesions are described. Diagnosis needs a high index of suspicion, confirmed by histological examination, as it still can occur occasionally in immunocompetent persons. Response to specific treatment is good after diagnosis.

Tuberculosis of the Lower Lumbar Spine with an Atypical Radiological Presentation: A Case Mimicking a Malignancy

A 65-year-old woman was treated for an atypical radiological presentation of spinal tuberculosis. Compared with previously reported cases, the following two different radiographic features were found. 1) Although there was multiple and skipped involvement of the vertebral body, the intervertebral disc was relatively preserved. 2) The presence of an epidural granuloma indicated an epidural extension of the lesion of the adjacent vertebral body. These findings strongly mimicked bone marrow infiltrative disease such as a malignancy. Tuberculosis was confirmed through an open biopsy and the patient was treated successfully with antitubercular chemotherapy. This case highlights the importance of being aware that spinal tuberculosis has many different radiographic features and can mimic a spinal malignancy.