Subdural tuberculous abscess of the lumbar spine in a patient with chronic low back pain.
2012
Introduction. Despite modern imaging methods, tuberculous abscess in the
subdural space of the spine can lead to misdiagnosis and to neurogical
complications development, even more up to paraplegia. We presented an
extremely rare case of subdural tuberculous abscess of the lumbar (L) spine
and paraparesis in imunocompetent a 49-year-old patient. Case report. A
patient with chronic L syndrome and a history of intervertebral (IV) disc L3
and L5 operations got severe back pain late in July 2007. At the same time
the patient had a purulent collection in the left knee, and was treated with
high doses of corticosteroids and antibiotics. Then, the patient got a high
fever, the amplification of pain in the L spine and the development of
paraparesis. Erythrocyte sedimentation rate was 108 mm/1 h, Creactive protein
106.0 mg/L, white blood cell (WBC) 38.4 x 09/L with a left turn. Magnetic
resonance imaging (MRI) of the spine was registered expansive formation in
the spinal canal, from the level of the IV disc L2 to the mid-L4 vertebral
body. This finding is a “spoke” in favor of the extrusion and sequestration
of IV disc L3 with the cranial and caudal migration. The patient underwent an
emergency neurosurgical operation. The diagnosis of subdural staphylococcal
abscess of L spine was made. According to the antibiogram antibiotic therapy
was applied but without effect on the course of the disease. Control MRI of
the L spine showed spondylodiscitis L3/L4, abscess collection in the spinal
canal and paravertebral muscle abscess. Late in September 2007 the patient
underwent needle biopsy of the L3 vertebral body guided by computed
tomography and the acid-fast bacilli (AFB) were found. Tuberculostatics were
introduced in the therapy. Two years later the patient was without
significant personal difficulties, and with normal clinical, laboratory and
morphological findings. Conclusion. Subdural tuberculous abscess of the spine
is extremely rare manifestation of spine tuberculosis. The exact and early
diagnosis and adequate treatment of atypical form of spine tuberculosis are
key factors of good prognosis.
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