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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(01): 165-173
DOI: 10.1055/s-0043-1760851
Case Report

Multifocal Tuberculous Spondylitis and Extensive Extraspinal Tubercular Osteomyelitis without Immunocompromise: Case Report and Literature Review

Divya Tomer
1   Department of Orthopaedics, B.J. Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
,
Girishchandra Bartakke
1   Department of Orthopaedics, B.J. Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
,
Shrikant Khose
1   Department of Orthopaedics, B.J. Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
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Abstract

Multifocal extensive spinal and extraspinal tuberculosis is very rare. So far, fewer than 10 cases have been reported. We hereby report two such cases to highlight their rarity, the diagnostic and therapeutic challenges they presented, and the overall prognosis of the condition. The two patients (a 19-year-old woman and another 20-year-old woman) had multifocal extensive tuberculosis involving spine and appendicular skeleton with neurological deficit. Both patients presented with back and neck pain and gradual neurological deficit. The insidious onset and malignancy-like spread pattern mimicked neoplasm. After thorough investigations with magnetic resonance imaging, positron emission tomography scan, and biopsy, antitubercular drug therapy was started, and debridement and fixation were done for significant thoracic and cervical vertebral lesions, respectively. Both patients showed excellent neurological recovery after the procedure. Early surgical treatment of the cases with large abscesses helped provide decompression and stabilization and prevented neurological deterioration and deformity. In patients with noncontiguous spinal tuberculosis, high percentage of surgical treatment may be required due to the aggressive behavior of the disease.

Keywords

multifocal tuberculosis - skipped lesions - extraspinal tuberculosis - tubercular spondylitis - skeletal tuberculosis

Authors' Contributions

D.T. acquired and analyzed the data and drafted the manuscript. G.B. conceptualized and designed the study. S.K. supervised the draft and provided critical revision ideas.




Publication History

Article published online:
29 March 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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