Joint Tuberculosis Research Articles

Clinical features and surgical management of tuberculous arthritis of the sacroiliac joint: a retrospective analysis of 33 patients

BackgroundWe reviewed 3 different types of tuberculous sacroiliitis via anterior and posterior approaches to determine the efficacy and safety of this surgical approach by describing clinical presentation, imaging, and surgical treatment.MethodsWe reviewed 33 patients with 3 different types of severe tuberculous sacroiliitis, of which 16 patients with anterior iliac abscess underwent anterior debridement. 17 patients underwent posterior debridement. Among them, 5 patients with lumbar tuberculosis underwent lesion debridement through fenestration, joint fusion, and interbody fusion and internal fixation. The mean postoperative follow-up was 16.9 months (12–25 months).Erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were used to judge the postoperative condition and functional recovery.ResultsAll patients’ hip, back and lower back pain symptoms were significantly relieved after surgical treatment. At 3 months after operation, the VAS and ODI scores of all patients decreased significantly.ConclusionSurgical treatment of tuberculous sacroiliitis should be performed as soon as possible under the adjuvant chemotherapy of anti-tuberculosis drugs. According to the different characteristics of sacroiliac joint tuberculosis, appropriate surgical operations should be adopted according to our classification criteria.

Physiotherapy Rehabilitation Strategies to Improve Clinical Outcomes Following Joint Debridement in the Case of Shoulder Joint Tuberculosis

Background: The shoulder joint tuberculosis (TB) is a rare disease. The shoulder joint is involved in 1–10.5% of the population with skeletal tuberculosis. The diagnosis of disease at an early stage is difficult, delaying the treatment and leading to poor quality of life. Case summary: A 48-year-old female with shoulder joint debridement in a case of right shoulder joint tuberculosis presented with complaints of pain, weakness, and functional immobility of the right shoulder. Physiotherapy rehabilitation was given to her three days a week for the period of four months, including electrotherapeutic modality, electrical stimulation, therapeutic exercises, and upper body ergometer training. Range of motion (ROM), muscle strength, and shoulder pain and disability index (SPADI) were used as outcome measures .As a result of physiotherapy rehabilitation, patient was able to achieve an optimal functional range of motion of flexion (from 10⁰ to 100⁰), abduction (from 20⁰ to 85⁰), extension (from 5⁰ to 15⁰), internal rotation (from 28⁰ to 35⁰) and external rotation (from 35⁰ to 40⁰), overall improvement in shoulder joint muscles strength from grade 2 to 3, and reduction in shoulder pain and disability index from 86% to 41% despite having marked bony destruction. Conclusion: Physiotherapy rehabilitation strategies were found to be effective for improving shoulder joint function after joint debridement in the case of shoulder joint tuberculosis. The patient achieved a functional state sooner than the patients documented in currently available literature for this diagnosis. KEY WORDS: Tuberculosis, Extra-pulmonary, Shoulder joint, Physiotherapy.

Treatment of Stage I-III Hip Joint Tuberculosis With Open Surgical Debridement and Hip Spica in Children: A Retrospective Study.

Background:This study aimed to evaluate the outcome of surgical debridement combined with postoperative hip spica immobilization in the treatment of hip joint tuberculosis in children.Methods:This retrospective study enrolled 87 children with stage I to III hip joint tuberculosis treated surgically at our hospital from January 2010 to January 2016. All patients considering hip tuberculosis routinely received a 4-week conservative treatment first, including rest, protected weight-bearing, and 4-drugs antitubercular chemotherapy. Surgical debridement was indicated when there was no relief after this conservative protocol. Patients were divided into 2 groups according to the duration of hip spica immobilization after operation: group A (hip spica for 4 wk, 39 patients) and group B (hip spica for 6 wk, 48 patients). All patients were recommended partial weight-bearing for 7 days and then followed the same hip joint exercises program when spica was removed. Postoperative radiographs, hip dislocation or subluxation, and modified Harris hip score (MHHS) were assessed. All patients were followed up at least 5 years.Results:There were 87 patients enrolled in our study, including 34 females and 53 males, with a mean age of 7.2±2.8 years old (range: 2 to 14 y). No significant difference was observed between these 2 groups in baseline data. In group A, the mean MHHS improved from 52.1±14.7 before surgery to 87.8±8.3 at the final follow-up (P<0.000). In group B, there was also a significant difference between the preoperative MHHS (52.7±9.4) and the final MHHS (88.6±6.5) (P<0.000). Although there was no significant difference between these 2 groups in the final MHHS (P=0.593), there were also no significant differences between these 2 groups in wound healing delay (3 in group A and 6 in group B, P=0.705) and pathologic subluxation (3 in group A and 1 in group B, P=0.467). The only difference between group A (79.2±8.5) and group B (75.5±7.5) was the early functional outcome assessed by using MHHS after 1 month of hip joint exercises (P=0.032).Conclusions:Surgical debridement combined with antitubercular chemotherapy is an effective treatment for stage I to III hip tuberculosis in children when there is no improvement after conservative treatment. Prolonged hip spica immobilization may not reduce the risk of hip subluxation after open surgical debridement but could lead to a delay in early functional recovery. Time of spica immobilization should be individualized and based on the surgeon’s evaluation and the patient’s condition.

Bone and Joint Tuberculosis in Greece: A Retrospective Study From 2011 to 2019.

Purpose: Bone and joint tuberculosis (BJTB) represents approximately 2-5% of all tuberculosis (TB) cases and its characteristics are infrequently discussed. The aim of this study was to examine the epidemiology, characteristics, and management of BJTB in Greece.Methods: We conducted retrospective analyses of demographic clinical and treatment data accessed from medical records of patients with BJTB and with pulmonary involvement between 2011 and 2019 from the national TB reference hospital in Greece. Factors associated with treatment outcomes among patients were evaluated.Results: Out of the total 3064 confirmed TB cases during the study period, 54 patients had either BJTB or skeletal TB with pulmonary involvement. The majority of patients were males (81.5%) and the mean age of the patients was 37.81±18.92 years. Out of the total patients, 11 were Greek and 43 were immigrants. Women had a higher probability of experiencing a stable or negative treatment outcome. Also, the patients that received therapy for less than nine months had 16.3 times higher probability of experiencing a stable or negative treatment outcome, compared to those that received therapy for more than 12 months.Conclusions: The study indicated that the sex and the duration of treatment correlated with the treatment outcomes. It is essential to monitor and accurately report treatment outcomes so as to achieve disease control.

Efficacy analysis of anterior debridement and bone graft fusion in the treatment of sacroiliac joint tuberculous arthritis: a retrospective analysis of 17 patients

BackgroundSacroiliac joint tuberculous arthritis is a relatively rare site of tuberculosis infection, but it can lead to severe sacroiliac joint destruction and dysfunction. Since there are few studies on the surgical methods of sacroiliac joint tuberculosis (SJT), we adopted three different surgical methods based on different degrees of destruction of sacroiliac joint tuberculous arthritis. While revealing its clinical symptoms to improve the diagnostic accuracy, and to determine the safety and feasibility of this surgical approach in the treatment of sacroiliac joint tuberculous arthritis.MethodsWe retrospectively analyzed 17 patients with tuberculous arthritis of the sacroiliac joint treated by anterior debridement. All these patients underwent anterior debridement of tuberculosis with or without bone graft fusion. Mean postoperative follow-up was 17.2 months (12–25 months). The erythrocyte sedimentation rate (ESR) was used to judge the general situation after surgery, and the fusion of sacroiliac joints was observed by X-ray films and CT scans. And VAS and ODI were used to score to observe postoperative functional recovery.ResultsAnterior approach debridement is an effective surgical approach for sacroiliac joint tuberculous arthritis. All patients achieved effective relief of lower back and hip pain. The pain was significantly relieved 3 months after the operation, and the pain basically disappeared 6 months after the operation. The erythrocyte sedimentation rate was also significantly reduced after the operation, and it can basically return to the normal level 3 months after the operation. The VAS score and ODI index of the other 16 patients after surgery were significantly lower than those before surgery, except for 1 patient who died of severe type I respiratory failure and septic shock 3 months after surgery, The surviving patients were basically able to achieve stable fusion of the sacroiliac joint at 12 months postoperatively. None of the patients reported significant pain until the last follow-up visit.ConclusionsThe anterior approach is a very effective surgical method for the treatment of sacroiliac joint tuberculous arthritis, and it is safe and feasible. A clear operative field of view facilitates complete debridement and reduces recurrence, and its function recovers well with stable arthrodesis.

99mTc-Ethambutol Scan with SPECT/CT in Knee Joint Tuberculosis.

Modalities for in vivo imaging of Mycobacterium tuberculosis are limited and inadequately studied. One such modality is 99mTc-ethambutol scintigraphy which has shown promising results for diagnosis of tuberculosis (TB). Ethambutol, one of the primary antitubercular drugs, is bacteriostatic which acts on the mycolic acid cell wall synthesis of the M. tuberculosis. However, literature on its utility is scarce. The few studies that exist have reported its sensitivity and specificity between 90%- 95% and 71%-85%. We present here a case demonstrating the role of 99mTc-ethambutol scan in knee joint TB.

Osteoid Osteoma of the Proximal Femur: Pitfalls in Diagnosis and Performance of Open Surgical Resection.

AimsProximal femoral osteoid osteoma (OO) is extremely easy to be misdiagnosed or missed. The purpose of this study was to retrospectively analyze the clinical data of patients with proximal femoral OO in order to determine the clinical manifestation and imaging characteristics of the disease, so as to provide help for the preoperative diagnosis and clinical treatment of proximal femoral OO.MethodsThis was a retrospective study involving 35 patients with proximal femoral OO admitted into our hospital from January 2015 to January 2021. The baseline characteristics of the participants included; 24 males and 11 females, aged between 13 and 25 (mean 16.2) years old, and the course of the disease was 1 to 14 (mean 6.3) months. We used previous medical experience records of the patients to analyze for the causes of misdiagnosis. Moreover, we compared the difference between preoperative and postoperative treatment practices in alleviating pain in OO patients and restoring hip function. Follow-ups were carried out regularly, and patients advised to avoid strenuous exercises for 3 months.ResultsWe followed up 35 patients (25 intercortical, 4 sub-periosteal, and 6 medullary) for an average of 41.4 months. We found that 15 patients (42.9%) had been misdiagnosed of synovitis, perthes disease, osteomyelitis, intra-articular infection, joint tuberculosis and hip impingement syndrome, whose average time from symptoms to diagnosis were 6.3 months. Postoperative pain score and joint function score improved significantly compared with preoperative, and complications were rare.ConclusionOpen surgical resection constitutes an effective treatment for proximal femoral OO by accurately and completely removing the nidus. Wrong choice of examination, and the complexity and diversity of clinical manifestations constitutes the main reasons for the misdiagnosis of proximal femoral OO.

Surgical Management of Spinal Tuberculosis-The Past, Present, and Future.

Tuberculosis is endemic in many parts of the world. With increasing immigration, we can state that it is prevalent throughout the globe. Tuberculosis of the spine is the most common form of bone and joint tuberculosis; the principles of treatment are different; biology, mechanics, and neurology are affected. Management strategies have changed significantly over the years, from watchful observations to aggressive debridement, to selective surgical indications based on well-formed principles. This has been possible due to the development of various diagnostic tests for early detection of the disease, effective anti-tubercular therapy, and associated research, which have revolutionized treatment. This picture is rapidly changing with the advent of minimally invasive spine surgery and its application in treating spinal infections. This review article focuses on the past, present, and future principles of surgical management of tuberculosis of the spine.

Surgical stabilization of appendicular joints in tuberculous arthritis: its place in treatment of osteoarticular tuberculosis

The objective: to analyze results of stabilizing techniques in the surgical treatment of tuberculous arthritis of appendicular joints, to define their place in treatment of tuberculous arthritis.Subjects and Methods. Data of 8 patients who underwent surgery for tuberculosis of appendicular joints were analyzed during the study. 7 patients suffered from tuberculosis of rare localization: ankle – 3 cases, foot – 1 case, wrist – 3 cases. And 1 patient suffers from tuberculosis of the knee joint, underwent arthrodesis, which eventually failed, had quadriceps fibrosis with no patella. At the time of the study, athroplasty couldn’t be performed in all 8 patients, so stabilizing surgery including arthrodesis was the method of choice. With the active tuberculosis disease and an extensive bone defect of the joint in 5 patients, static cement spacers loaded with anti-tuberculosis drugs were used. Spacers were used both for two-stage surgical treatment (2 cases) and one-stage (3 cases).Results: in all 8 cases, the stable eradication of tuberculosis infection was achieved with a follow-up period from 6 months to 7 years, average duration of follow-up made 2.2 Ѓ} 1.4 years. In 5 patients with tuberculosis of the ankle, foot and former knee joint, the support ability of the extremity was restored. With the stabilization of the wrist in a functionally advantageous position, all 3 patients showed a significant improvement in hand functions. After the spacer was installed, all patients were scheduled for the second stage of the operation but 3 of them achieved a good functional result, thus it was possible to avoid the next stage. The main criterion for stabilizing surgery of joints may be the impossibility of performing arthroplasty in cases of extensive bone defects as well as in case of persistent loss of anatomical structures.

Development of Polycaprolactone Infiltrated Anti-Tuberculosis Drug-Loaded 3D-Printed Hydroxyapatite for Localized and Sustained Drug Release in Bone and Joint Tuberculosis Treatment

Bone and joint tuberculosis is one of extrapulmonary tuberculosis that is commonly found globally. Treatment of bone tuberculosis typically involves long term oral medication and frequently causes side effects due to its systemic administration route. In order to mitigate the side effects and to increase the performance, the use of localized medication for sustained drug release was investigated. Three first-line anti-tuberculosis drugs were loaded into three-dimensional printed hydroxyapatite (3DP HA) by vacuum infiltration and then further infiltrated by low molecular weight polycaprolactone (PCL). It was observed that PCL uniformly coated on the surface and filled the inside pores of all infiltrated samples and did not much affect the drug loading content in the samples. Rifampicin (RIF) loaded samples, either non-infiltrated or infiltrated ones, displayed longer sustained release than those of isoniazid (INH) or pyrazinamide (PZA) loaded samples, but the release of infiltrated samples could be further enhanced in terms of released content and duration. These were related to the drug solubility and diffusion distance of drugs in the samples. Bioactivity of the drug-loaded samples was also not hampered as the apatite layer was seen to grow on the surface ascertaining its role as a dual functioned bone graft.

Preparation and Biocompatibility Evaluation of Nanoscale Isoniazide-Loaded Mineralized Collagen Implants for Tuberculous Bone and Joint Repair.

Bone and joint tuberculosis is an extremely severe infectious disease that commonly occurs due to the primary infection of a type of mycobacteria, called Mycobacterium tuberculosis. Under the current scenario, there are very limited supplies of bone grafts available for the treatment of deceased bone, including autogenous bone and synthetic biomaterials. The present study aimed to construct a nanoscale isoniazid-loaded mineralized collagen implant, and then to explore its physicochemical properties and to investigate its biocompatibility suitable for bone and joint repair. Using type I collagen as raw material and the principle of biomimetic mineralization for self-assembly of bone tissue, a new drug-loaded mineralized collagen implant was constructed by molecular coprecipitation with isoniazid. Its surface morphology, elemental composition, and porosity were characterized by field emission scanning electron microscope (SEM), X-ray diffraction (XRD), and pycnometer. The performance of the implant was gauged by sustained release and degradation, which were studied using an ultraviolet spectrophotometer and a simulated in vivo environment. The drug loading and encapsulation rates of the implants were (6.25 ± 0.48)% and (54 ± 2.34)%, respectively. The in vitro release time of the scaffold was more than 12 weeks and the degradation performance was excellent. The scaffold was then implanted into mice, and the inflammatory reaction of local tissue was observed by Haemotoxylin and Eosin (H&E) and Masson. The in vivo evaluation in mice showed that the scaffold was biocompatible. Overall, compared with traditional drug loading systems, the isoniazid biomimetic mineralized collagen implant constructed here has better drug release performance, biodegradability, and biocompatibility. This kind of collagen implant may find potential applications in tuberculous bone and joint repair.

Synovial tuberculosis in wrist diagnosed based on metagenomic next-generation sequencing: A case report

Synovial tuberculosis in the wrist is a rare disease that is usually misdiagnosed at the early stage. In this case, we presented a 67-year-old male with wrist joint tuberculosis who presented repeated left wrist joint edema for more than 2 years. The patient received surgery twice. During the second surgery, the combination of metagenomic next-generation sequencing (mNGS) and pathological analysis contributed to the detection of Mycobacterium tuberculosis in lesion tissues. Conventional anti-tubercular therapy confirmed the diagnosis of synovial tuberculosis in the wrist joint. In conclusion, mNGS contributed to the rapid and accurate detection of tubercle bacillus.

3D-Printed Porous Tantalum Coated with Antitubercular Drugs Achieving Antibacterial Properties and Good Biocompatibility.

Treatment of bone and joint tuberculosis remains a challenge. The development of tissue-engineered drug-loaded biomaterials has increased the therapeutic options. However, for the treatment of osteoarticular tuberculosis with severe local infection risks and high weight-bearing requirements, it is still necessary to design materials consistent with bone biomechanics, cytocompatibility, and osteogenesis and to provide more effective antimicrobial functions. The antitubercular drugs isoniazid and rifampicin are loaded with gellan gum, and a 3D-printed porous tantalum surface is treated with polydopamine to increase adhesion. The osteogenic induction and differentiation are tested using alkaline phosphatase, alizarin red staining, sirius red staining, and polymerase chain reaction testing. Bone regeneration in vivo is measured by X-ray, micro-computerized tomography, hard tissue sections, and fluorescence staining. The drug is released slowly in vitro and in vivo, increasing the duration of antibacterial action. The composite bio-scaffolds inhibit Staphylococcus aureus growth, have good biocompatibility, and does not inhibit the induction of osteogenic differentiation of rat bone marrow mesenchymal stem cells. The composite bio-scaffold can simultaneously achieve localized long-term controlled drug release and bone regeneration and is a promising route for bone and joint tuberculosis treatment.

Incidence of extrapulmonary tuberculosis in the territory of the Kyrgyz Republic

Extrapulmonary tuberculosis is widespread in the territory of the Kyrgyz Republic (KR). General practitioners fail to diagnose in time a significant number of cases of extrapulmonary tuberculosis. In the Kyrgyz Republic, in 2019 the incidence of extrapulmonary tuberculosis made 19.5 per 100,000 population, tuberculous exudative pleurisy (50.6%) and bone and joint tuberculosis (18.1%) prevailed in the structure.

The application of molecular genetic tests using paraffin‑embedded biopsy specimens in the diagnosis of bone and joint tuberculosis.

The application of molecular genetic tests using paraffin‑embedded biopsy specimens in the diagnosis of bone and joint tuberculosis.

Longstanding Complicated Wrist Swelling: A Typical Presentation of Primary Tuberculosis a Case Report and Mini Review

Tuberculosis of the wrist joints is an uncommon clinical entity that most frequently presents with insidious pain and swelling. Isolated carpal bones involvement due to tuberculosis is a relatively uncommon event. In this report, the authors describe the case of a 36-year-old female patient presenting with fracture of the scaphoid bone. The diagnosis of tuberculosis was suspected based on the ultrasound and magnetic resonance imaging findings of the wrist joint, and confirmed by joint fluid culture. Introducing anti-tuberculous drugs under appropriate supervision resulted in clinical improvement and optimal regain of function. No reactivation of the disease was noted after 2 years of follow‑up. This case report describes a rare presentation of wrist joint tuberculosis.

Possibilities of Therapeutic and Prophylactic Tactics in Management of Benign Prostatic Hyperplasia in Tuberculosis Patients

The objective: to assess the severity of symptoms of urinary dysfunction in tuberculosis patients with benign prostatic hyperplasia (BPH) and determine the effectiveness of comprehensive therapeutic and preventive measures aimed at their elimination as well as the possibility of their combination with anti-tuberculosis therapy.Subjects and Methods. 447 men with various localizations of tuberculosis at the age from 20 to 96 years old were examined. The questionnaire we used included questions regarding lower urinary tract symptoms, urinary tract infection, involuntary urination, and male genital disorders. The assessment involved comprehensive clinical and laboratory evaluation, including objective examination, laboratory and echographic tests of genitourinary organs.Results. According to assessment results, among 447 male tuberculosis patients, 88 (19.7%) were diagnosed with benign prostatic hyperplasia which indicated a large proportion of older men with various forms of tuberculosis. Analysis of the structure of tuberculosis clinical forms showed the highest frequency of benign prostatic hyperplasia in patients with infiltrative pulmonary tuberculosis (51.1%) and bone and joint tuberculosis (26.1%). Medical treatment (tamsulosin 0.4 mg once a day for 3 months) in 66 patients was highly effective – up to 80.3%.

A 20-year retrospective study of osteoarticular tuberculosis in a pediatric third level referral center

PurposeThe objective of the present study is to describe the clinical, diagnostic, radiological and therapeutic aspects of osteoarticular tuberculosis (OATB) in patients in a tertiary pediatric hospital, to know if the diagnosis of OATB in pediatrics is a challenge due to its insidious clinical presentation.MethodsA retrospective, descriptive study of the cases of Tuberculosis (TB) in children was carried out. A total of 159 cases met the condition for the analysis.ResultsThe most frequent TB modality was extrapulmonary in 85%. Out of this, only 29% was OATB. The mean age was 4.9 years (range 8 months–16 years). Eighty-six per cent of cases received Bacille Calmette-Guérin (BCG) vaccination at birth. Median time of symptoms prior to diagnosis was 8 months. Microbiological confirmation was achieved only in five cases, with a high sensitivity to the antimicrobial treatment. Mycobacterium bovis BCG strain Tokio 172 was confirmed in three cases. Mortality rate was 0% during the time of studyConclusionOur study describes the epidemiological characteristics of OATB cases in Mexican children. This data revealed a high prevalence of bone and joint TB infection. Pediatric OATB should be considered in cases with lytic bone lesions, fever and local pain. In countries with BCG immunization program, M. bovis should not be forgotten as an etiological agent. The low detection rate with one technique approach highlights the urgent need for more sensitive test to diagnose OATB in children.

Clinical application of percutaneous spinal endoscopy debridement and lavage in sacroiliac joint tuberculosis

To investigate the feasibility and clinical efficacy of percutaneous spinal endoscopic debridement and lavage for the treatment of sacroiliac joint tuberculosis. The clinical data of 7 patients with sacroiliac joint tuberculosis treated with percutaneous spinal endoscopic debridement and lavage from January 2007 to April 2009 were retrospectively analyzed. There were 2 males and 5 females, aged from 29 to 69 years old, 4 cases on the right side of the lesion and 3 cases on the left side. The course ranged from 8 to 144 months. According to Kim classification, 5 cases were type Ⅲ and 2 cases were type Ⅳ. All patients were treated with HRZE quadruple anti tuberculosis drugs for 2 to 6 weeks beforeoperation. VAS, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Oswestry Disability Index (ODI) were compared before and after surgery. All the operations were successful, the intraoperative blood loss was less than 50 ml on average, and no complications such as hematoma and infection were occurred. The follow-up time of 7 cases ranged from 18 to 40 months. Pain relief was obvious, and there was a statistical result in the VAS, ESR, and ODI of the patients at 1, 3, 6, 12, 18 months after operation compared with before treatment. At the final follow-up, the patient's clinical, imaging and laboratory examinations showed that the infection had disappeared, and the patient returned to normal life and work. Percutaneous spine endoscopic debridement and lavage has less tissue trauma, targeted operation, definite curative effects, and quick postoperative recovery, which has explored new options for minimally invasive treatment of sacroiliac joint tuberculosis.

Extrapulmonary tuberculosis

Introduction: Tuberculosis (TB) is a major cause of morbidity and mortality globally. Extrapulmonary TB (EPTB) constitutes about 15%-20% of all TB patients but accounts for 50% among HIV-coinfected. Confirmation of microbial diagnosis of EPTB is usually challenging. Areas covered: Availability of newer imaging modalities like 18FDG-PET-CT, PET-MRI, has facilitated precise anatomical localization of the lesions and mapping the extent of EPTB. The use of image-, endoscopy-guided invasive diagnostic methods has made procurement of tissue/body fluids for diagnostic testing possible. With the advent of universal drug-susceptibility testing, a rapid diagnosis of drug-resistance is now possible in EPTB. Drug-susceptible EPTB usually responds well to first-line anti-TB treatment; TB meningitis, bone and joint TB and lymph node TB often require longer duration of treatment. Expert opinion: Adjunctive use of corticosteroids in the initial period is recommended in central nervous system and pericardial TB. Surgical intervention is helpful to obtain tissue samples for diagnosis. Adjunctive surgical treatment along with medical treatment is useful in treating complications like hydrocephalus, Pott’s spine. Follow-up of EPTB patients is crucial as treatment is usually longer, requires recognition of development of immune reconstitution and inflammatory syndrome (IRIS), monitoring of adverse events, serious adverse events like anti-TB drug-induced hepatotoxicity, organ-related complications and treatment adherence.