Dados do Trabalho

Título

Spinal tuberculosis mimicking a compressive paravertebral tumor: a case-based update

RESUMO

Case presentation: A 32-year-old immunocompetent male patient developed low back pain that, after 7 months, evolved with paresthesia of the left lower limb (LL), followed by paraparesis, paraparesthesia, and sphincter incontinence. Neurological exam revealed T10 sensory level, muscle strength grade 2/5 in limbs, patellar and aquileu reflexes grade 4/4, Babinski’s and switchblade sign present, and diffuse clonus. Magnetic resonance imaging (MRI) of the spine was performed, which suggested extensive spinal neoplasia, with involvement of the vertebral body on T4 and significant spinal cord compression. A laminectomy was performed, raising the possibility of tuberculosis (TB) vertebral. The regimen for TB was started for 2 months, until the diagnosis was confirmed with a positive sputum test for BK, and the regimen was extended to 12 months. On the 11th postoperative day, the anatomopathological examination revealed chronic granulomatous osteomyelitis with a tuberculoid pattern, without malignancy criterion. After 5 months, he was readmitted with multiple T1 to T6 lytic lesions and extensive subcutaneous collection, consistent with an infectious process. Drainage was performed and antibiotic therapy was started. He had a new infectious condition 2 months after discharge, requiring another decompressive laminectomy, drainage of the collection and an antibiotic regimen for 42 days. Since then, it has evolved with significant neurological improvement, with gains in strength and physiological sphincter functions.
Discussion: Responsible for 1-2% of TB cases, spinal involvement, more common in immunocompromised patients, results from hematogenous dissemination, with the thoracolumbar junction being the most affected site. The manifestations are nonspecific, insidious and progressive, in order to mimic many other clinical conditions, such as paravertebral tumors themselves, which makes the diagnosis a challenge. MRI is the best imaging test for this extrapulmonary form of TB, but it is worth noting that radiological tests are not always capable of making this diagnosis. As a result, the anatomopathological study is the gold standard. Treatment lasts 12 months, while the prognosis depends, in part, on the degree of established neurological impairment.
Final comments: It is important to be aware of the different presentations of spinal TB, which can often mimic a malignancy, in order to avoid diagnosis and treatment delay.

Palavras Chave

spinal tuberculosis, differential diagnosis, pott’s disease

Área

Neuroinfecção