Paraplégie Brutale Sur Spondylodiscite Tuberculeuse Chez Un Patient Hémodialysé.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 5
Abstract
Introduction: Tuberculous spondylitis represent 50% of cases of osteoarticular tuberculosis. It is more common in patients with end stage renal disease and is life-threatening. The diagnosis is often delayed, made at the stage of complications. Given the difficulty of obtaining a diagnostic with certainty, it is necessary to think of new tests such as Xpert MTB/RIF Ultra assay using automated real-time nucleic acid amplification technology. Observation: A 58-year-old diabetic man on chronic hemodialysis for 5 months was admitted for intermittent chest pain and weight loss. The biological assessment noted a frank inflammatory syndrome. The infectious investigation remained negative. An empiric antibacterial therapy has been introduced, leading to a slight improvement.Spinal MRI performed for sudden paraplegia and sphincter disorders showed dorsal spondylitis and spinal cord compression at the level of fourth and fifth dorsal vertebrae. A biopsy with CT guidance was performed, histopathology found a non-specific inflammation and culture did not isolate pathogens.QuantiFERON-TBGold Plus test came back positive. Once the diagnosis of tuberculous spondylitis was made, antituberculous therapy was started resulting in a dramatic immediate outcome.However, the patient died due to immobility complications, 6 weeks later. Conclusion: Tuberculous spondylodiscitis is more common in chronic hemodialysis patients. Tuberculous origin should always be suspected in cases of unexplained pain. Culture and histopathology make the diagnosis of certainty, while new Xpert MTB/RIF Ultra assay may take place in some cases where these investigations remain difficult or inconclusive.
Authors and Affiliations
Hassani Mohamed
Keywords
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- DOI 10.9790/0853-1705036670.
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