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J Neurol Surg A Cent Eur Neurosurg 2023; 84(01): 91-94
DOI: 10.1055/s-0042-1746171
Case Report

Spinal Tuberculosis within the Vertebral Arch Mimicking a Malignant Tumor: Case Report

Sebastian Niedermeyer
1   Department of Neurosurgery, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
,
Rika Draenert
2   Antibiotic Stewardship, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
,
Alexander Beck
3   Center for Neuropathology and Prion Research, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
,
Rumyana Todorova
4   Institute of Pathology, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
,
Andreas Jung
4   Institute of Pathology, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
,
Anna-Maria Biczok
1   Department of Neurosurgery, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
,
Jörg-Christian Tonn
1   Department of Neurosurgery, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
,
Jun Thorsteinsdottir
1   Department of Neurosurgery, Ludwig Maximilians University Munich Faculty of Medicine, Munchen, Bayern, Germany
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Abstract

Background Spinal tuberculosis is a manifestation of extrapulmonary tuberculosis. The incidence of tuberculosis is low in high-income countries; however, globally, it still remains one of the most frequent fatal infectious diseases. Because of its rarity in developed countries, spinal tuberculosis can be mistaken for malignant tumors of the spine, especially in case of an atypical radiologic manifestation and without pulmonary affection.

Methods We present the case of a 39-year-old man from South India with quickly progressing gait disturbance and hypesthesia below the Th10 level. Magnetic resonance imaging revealed an osteolytic lesion of the vertebral arch Th2 with central necrosis and compression of the spinal cord altogether highly suspicious for spinal metastasis.

Results After surgical removal of the mass by laminectomy, the patient regained normal neurologic function. Histology revealed a severe granulomatous inflammation and DNAhybridization of polymerase chain reaction (PCR) products detected Mycobacterium tuberculosis-specific DNA in the sample. Biopsy of an enlarged hilar lymphnode allowed us to obtain material to successfully perform a drug resistance test to start specific antimicrobial therapy.

Conclusion Spinal tuberculosis, even with atypical radiologic appearance, has to be considered a differential diagnosis in patients with provenance from endemic countries. A multidisciplinary diagnostic approach helps perform antimicrobial susceptibility testing to avoid delaying the start of antibiotic therapy.

Keywords

spinal tuberculosis - spinal tumors - Pott's disease - Mycobacterium tuberculosis


Publication History

Received: 23 April 2021

Accepted: 19 January 2022

Article published online:
03 June 2022

© 2022. Thieme. All rights reserved.

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