Musculoskeletal Tuberculosis Involving Ribs, Spine, and Pelvis in a 17-year-old Girl: A Case Report

Authors

  • Lina Hammoud, MD American University of Beirut Medical Center, Beirut, Lebanon
  • Yara Neaimeh, MD American University of Beirut Medical Center, Beirut, Lebanon.
  • Katia El Taoum, MD American University of Beirut Medical Center, Beirut, Lebanon
  • Ramia Zakhour, MD American University of Beirut Medical Center, Beirut, Lebanon

DOI:

https://doi.org/10.38179/ijcr.v3i1.167

Keywords:

Musculoskeletal tuberculosis, Potts disease, Back pain, Tuberculous spondylitis, Gibbus deformity

Abstract

Background: We present a case of progressive back pain associated with weight loss and low-grade fever in a 17-year-old patient previously diagnosed with spinal tuberculosis (TB) also known as tuberculous spondylitis or Pott’s disease.

Case presentation: Upon the patient's presentation to the clinic, a differential diagnosis including infectious and non-infectious causes such as extra-pulmonary tuberculosis, septic arthritis, malignancy, rheumatologic diseases, and physical abuse was made. Her preliminary workup was suggestive of granulomatous disease. A positive tuberculin skin test (TST), and a polymerase chain reaction (PCR) test of the tissue with mycobacterium tuberculosis deoxyribonucleic acid (MTB DNA), confirmed the diagnosis of musculoskeletal TB.

Conclusion: The patient was treated with anti-TB regimen and Pyridoxine to avoid peripheral neuropathy associated with isoniazid use. Her clinical follow-up showed improvement with a proper response to treatment and no sequelae.

References

Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res. 2004;120(4):316-53. PMID: 15520485.

Moon MS, Kim SS, Lee BJ, et al. Spinal Tuberculosis in children: retrospective analysis of 124 patients. Indian J Orthop. 2012;46(2):150-8. PMID: 22448052. https://doi.org/10.4103/0019-5413.9367610.4103/0019-5413.93676

Wu M, Su J, Yan F, et al. Skipped multifocal extensive spinal tuberculosis involving the whole spine: A case report and literature review. Medicine (Baltimore). 2018;97(3):e9692. PMID: 29505022. https://doi.org/10.1097/MD.0000000000009692

Rasouli MR, Mirkoohi M, Vaccaro AR, et al. Spinal tuberculosis: diagnosis and management. Asian Spine J. 2012 Dec;6(4):294-308. PMID: 23275816. https://doi.org/10.4184/asj.2012.6.4.294

Shen Y, Zhong W, Peng D, et al. Atypical, multilevel and noncontiguous tuberculous spondylitis that affected the vertebrae of thoracic, lumbar and sacrum: a case report. Int J Clin Exp Med 2015;8(2): 3006-3009. PMID: 25932273.

WHO. Diagnosis and treatment: TB, HIV-associated TB and drug-resistant TB. Global Tuberculosis Report 2018. Geneva: World Health Organization; 2018;67-102

Centers for Disease Control and Prevention, Division of Tuberculosis Elimination. Executive commentary. Reported Tuberculosis in the United States, 2017. Atlanta: US Department of Health and Human Services, CDC; October 2018;1-6

Benzagmout M, Boujraf S, Chakour K, et al. Pott's disease in children. Surg Neurol Int. 2011;2:1. PMID: 21297923. https://doi.org/10.4103/2152-7806.75459

Cormican L, Hammal R, Messenger J, et al. Current difficulties in the diagnosis and management of spinal tuberculosis. Postgrad Med J. 2006;82(963):46-51. PMID: 16397080. https://doi.org/10.1136/pgmj.2005.032862

Batirel A, Erdem H, Sengoz G, et al. The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study. Clin Microbiol Infect. 2015;21(11):1008-e9-1008.e18. PMID: 26232534. https://doi.org/10.1016/j.cmi.2015.07.013

Ye M, Huang J, Wang J, et al. Multifocal musculoskeletal tuberculosis mimicking multiple bone metastases: a case report. BMC Infect Dis 2016;16:34. PMID: 26823075. https://doi.org/10.1186/s12879-016-1376-7

Marudanayagam A, Gnanadoss JJ. Multifocal skeletal tuberculosis: a report of three cases. Iowa Orthop J. 2006;26:151-3. PMID: 16789468.

Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Cin Infect Dis. 2016;63(7):e 147-e195. PMID: 27516382. https://doi.org/10.1093/cid/ciw376

MRC Working party on tuberculosis of the spine, Darbyshire J. Five-year assessment of controlled trials of short-course chemotherapy regimens of 6, 9 or 18 months’ duration for spinal tuberculosis in patients ambulatory from the start or undergoing radical surgery. Fourteenth report of the Medical Research Council Working Party on Tuberculosis of the Spine. Int Orthop. 1999;23(2):73-81. .PMID: 10422019. https://doi.org/10.1007/s002640050311

A controlled trial of six-month and nine-month regimens of chemotherapy in patients undergoing radical surgery for tuberculosis of the spine in Hong Kong. Tenth report of the Medical Research Council Working Party on Tuberculosis of the Spine. Tubercle 1986 Dec;67(4):243-59. PMID: 2889281. https://doi.org/10.1016/0041-3879(86)90014-0

Nene A, Bhojraj S. Results of nonsurgical treatment of thoracic spinal tuberculosis in adults. Spine J 2005;5(1):79–84. PMID: 15653088. https://doi.org/10.1016/j.spinee.2004.05.255

Lifeso RM, Weaver P, Harder EH. Tuberculous spondylitis in adults. J Bone Joint Surg Am. 1985;67(9):1405-13. PMID: 4077912.

Upadhyay SS, Sell P, Saji MJ, et al. Surgical management of spinal tuberculosis in adults. Hong Kong operation compared with debridement surgery for short and long term outcome of deformity. Clin Orthop Relat Res. 1994;(302):173-82. PMID: 8168297.

Boxer DI, Pratt C, Hine AL, et al. Radiological features during and following treatment of spinal tuberculosis. Br J Radiol. 1992;65(774):476-9. PMID: 1628177. https://doi.org/10.1259/0007-1285-65-774-476

Kalita J, Misra UK, Mandal SK, et al. Prognosis of conservatively treated patients with Pott's paraplegia: logistic regression analysis. J Neurol Neurosurg Psychiatry. 2005;76(6):866-8. PMID: 15897514. https://doi.org/10.1136/jnnp.2004.037051

High STIR and low T1 signal with enhancement post contrast in left iliac bone

Published

2022-06-16

How to Cite

Hammoud, L., Neaimeh, Y., El Taoum, K. ., & Zakhour, R. (2022). Musculoskeletal Tuberculosis Involving Ribs, Spine, and Pelvis in a 17-year-old Girl: A Case Report. International Journal of Clinical Research, 3(1), 48-53. https://doi.org/10.38179/ijcr.v3i1.167