VERTEBRAL TUBERCULOSIS FOLLOWED BY TRAUMATIC SPINE FRACTURE IN A CHILD -RARE CASE REPORT

Abstract

Background Vertebral tuberculosis following a spinal trauma is a rare identity presenting as extrapulmonary TB associated with high degree of morbidity in a growing children. The objective of this report is to describe a paediatric case of traumatic spine fracture on the lower thoracic spine with tuberculosis disease. And thus show the importance of identifying the disease as soon as possible, because it is a rare and severe condition that can leave to serious sequelae. Case summery A adolescent boy presents to the orthopaedic OPD with the complaints of unable to walk, evening raise of temperature, loss of weight, deformity of spine since 3 months. Upon detail history, 3 months back child had a traumatic event following which he developed weakness of both the lower limbs. In the subsequent time he started developing evening rise of temperature, lethargy and loss of weight. His mother observed postural alteration, with constant pain in the middle back region with a deformity formation, unable to walk, inability to ex the lumbodorsal spine and pain on touching surrounding skin area. Clinical examination revealed that the child was pale, emaciated and afebrile with weight of 25 kgs. A tender gibbus was present over the dorso-lumbar region. Sensation of perianal region was intact with spasticity of both lower limbs. The bladder and bowel function were spared. No other external signs of inammation were detected. The rest of the physical examination was non-contributory. No prior history of contact with the tuberculosis patient. Mantoux test and Sputum examination was done. Radiologic evaluation done in the form of radiograph and magnetic resonance imaging. ConclusionSpinal tuberculosis is haematogenous in origin, and usually follows pulmonary tuberculosis. The two conditions may occur concomitantly, as is commonly seen in young children. Spinal tuberculosis is usually associated with a poor nutritional status and a depleted immune response. In our patient the source of infection might have been from a latent focus in the hilar nodes of the lung, although the patient denied any previous history of tuberculosis. Possibly after severe trauma the patient's immunity was lowered this has led to spread of the tuberculosis infection and the vertebral fracture hematoma could have provided a nidus for infection.