An Unusual Case of Craniovertebral Junction Tuberculosis in an Infant

Abstract

We present, to the best of our knowledge, the first reported case of craniovertebral junction tuberculosis with complete quadriplegia in an infant. To describe report of an unusual case and discuss the difficulties and peculiarities of diagnosis, management, and follow-up of craniovertebral tuberculosis in an infant. Spinal tuberculosis is prevalent in areas where tuberculosis is endemic, and its incidence is on the rise in developed nations with the rising incidence of HIV/AIDS. Although common in children and young adults, spinal tuberculosis is rare in infants. Again, craniovertebral tuberculosis is one of the rarest forms of spinal tuberculosis. The infant presented to us at the age of 9 months with Grade IV quadriplegia. Among many of the clinical differential diagnoses, craniovertebral tuberculosis was suspected only on MRI and proved after fine needle aspiration cytology demonstrated granulomas. The patient was subjected to transoral debridement, immobilized with help of a pair of pillows by either side of the head and multidrug antitubercular treatment was started, which continued for duration of 12 months. At the last follow-up of 1 year, the patient had recovered fully and caught up with the milestones suitable for her age. Craniovertebral tuberculosis is difficult to diagnose and treat in infants. A high index of suspicion is essential for a prompt diagnosis and treatment, which is all the more crucial in this age group.