Abstract
In spite of being a common diagnosis in the patients of Asian origin, atypical presentations of tuberculosis may pose diagnostic challenges. We report a huge prevertebral abscess in a 30-year-old female, mimicking a leaking aortic aneurysm. The patient was managed successfully by emergency decompression and stabilization. The issues related to poor patient compliance to chemotherapy and management of atypical presentations of spinal tuberculosis are discussed here.
Highlights
Tuberculosis is considered to be a disease of underdeveloped countries, but the incidence is rising in the western world due to increasing incidence of acquired immunodeficiency syndrome (AIDS)
We describe a rare case of massive thoracic paraspinal tubercular abscess presenting as a large pulsatile epigastric mass simulating a leaking aortic aneurysm
SadrcFiboaeioggsrrcitdutreatruasnectslgtMuD4eiolxRa7nt/ei8iovmnenadarnigotndefgbDsfrprha1oioln0mwba/1loinD1cdgoi6welausittmohohunfDsgDile1ge7n2apadrtleioncvghDealrts1not2egwkebriisrtenhas(klauistnrleutrgviboneoewgrfrehicsneupaliandnrastle) Sagittal MR image showing a huge prevertebral tubercular abscess extending from D6 to D12 levels with severe destruction vertebral bodies of D7 to D12 resulting in anterior angulation of spinal column leading to kinking of spinal cord at D7/8 and D10/11 with signal changes
Summary
Tuberculosis is considered to be a disease of underdeveloped countries, but the incidence is rising in the western world due to increasing incidence of acquired immunodeficiency syndrome (AIDS). A 30-year-old housewife of Asian origin diagnosed to have pulmonary tuberculosis, was referred to spinal team as cauda equina lesion by her general practitioner. She was on antitubercular treatment (ATT) for last three months and, had history of progressive weakness in lower limbs for a week with urinary incontinence for a day. Whereas a sensory level at D9 with upper motor neuron signs in lower limbs (increased jerks and up-going planters) indicated a compressive lesion at D9, urinary retention along with decreased perianal sensations and, impaired anal tone and reflexes favoured a clinical diagnosis of cauda equina compression. Follow-up x-ray revealed a satisfactory spinal fusion and well aligned prosthesis in situ
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