Abstract
Skeletal tuberculosis is the main extrapulmonary site for Mycobacterium tuberculosis infection disemination. As for the nervous sistem tuberculosis or spinal tuberculous disease in particular, the osseos elements are more frequently involved than the cerebral tissue or the spinal cord. We present the case of a previously healthy 32 year old female with no known TB history, reffered to our clinic for neck pain thought to be due to degenerative spinal disc disease. In the absence of general signs of the disease, the right surgical management and biopsy were the key factors for corect diagnosis.
Highlights
Extrapulmonary tuberculosis (TB), especially spinal TB, is a very rare entity nowadays, even in Romania, a country that as of 2020 is still an endemic zone for pulmonary tuberculosis according to the latest ECDC reports [1].One in five patients infected with Mycobacterium tuberculosis are expected to manifest extrapulmonary tuberculosis at some point in life [2,3]
Nervous system tuberculosis is still a major challenge, both in developed and underdeveloped countries, with regard to the surgical management and when it comes to reaching the right diagnosis [3]
Skeletal TB is primarly discoved on plain X-rays, but further imagery studies such as MRI help characterise the lesion and clarify its etiology [5,6]
Summary
Extrapulmonary tuberculosis (TB), especially spinal TB, is a very rare entity nowadays, even in Romania, a country that as of 2020 is still an endemic zone for pulmonary tuberculosis according to the latest ECDC reports [1]. Local examination revealed neither stiff neck nor dystonia She underwent a cervical spinal and cerebral MRI, both plain and with intravenous contrast enhancement, that revealed a unique lesion – a space occupying mass located extramedullary, extradural and posteriorly in the cervical spinal canal between C2 and C4, about 2 centimeters long and 0.5 cm thick. Bone structure at this level was within normal limits, but the C2 laminae was thiner, which is thought to be a result of local bone compression. Pre-operatory workup, including blood work and pulmonary films did not reveal any abnormal findings: no anemia, no inflamatory markers, no suspicious radiological findings
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