Tuberculosis Spine in Neonate: A Case Report

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Tuberculosis Spine in Neonate: A Case Report

Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 10, Issue 3

Abstract

Spinal tuberculosis, TB prevalence is increasing across the world but with very little to almost zero data regarding its prevalence in neonates. The complications of spine TB can be as devastating as causing irreversible paraplegia, bone destruction and severe spine deformity which then lead to spinal cord decompression, cardiopulmonary dysfunction. Detecting spine TB in infants at early stage might be difficult as the disease often present with vague symptoms with neurological deficit only manifested at the later stage as demonstrated in our case. Therefore, a clear background history is very crucial in treating any patients with possibility of having TB spine. In many cases, medical treatment alone has good outcome and even improve neurological involvement if treated early. More study however, is required to assess the long-term outcome of Spine TB in neonates and children. We report a case of 2 months old female infant sustained extrapulmonary TB with spinal TB. This case emphasizes on difficulty in diagnosis and challenge in treating neonate TB spine in our centre.Spine TB is a destructive form of tuberculosis [1]. There is a report that suggest the incidence is increasing in developed countries primarily from immigrants from endemic nations. The exact prevalence of spine TB however is not known. About 10 % of patient with extra pulmonary TB have skeletal involvement and spine TB accounts for 50% out of this number followed by hip and knee [2]. Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurological deficit due to compression of the adjacent neural structures and significant spinal deformity [3]. Therefore, early detection of spine TB is very crucial. Data on childhood musculoskeletal TB however is very rare. The minimum time required for osteoarticular tuberculosis to manifest is postulated as one year after the primary infection hence it is extremely unusual to present before one year of age [4,5].A two months old female infant presented to us with persistent fever and cough. This patient was initially suspected to have pneumonia with MRSA bacteremia. She was treated with IV Azithromycin and IV Vancomycin for one week. Serial chest X ray was done and showed persistent unresolved right upper lobe consolidation which is highly suspicious of complicated pneumonia or abscesses (Figures 1 & 2). On examination gibbus deformity was noted at the back of the patient (Figure 1). An urgent MRI was done to distinguish diagnosis between spondylodiscitis or TB spine. Clinical examination and radiology investigation strongly suggest for TB spine as destructive bone changes were noted involving T7, T8 and T9 vertebra body (Figure 3). Further history reveals that the patient was taken care by an Indonesian care taker since birth. However, further investigations and history are needed to confirm the source of TB contact.

Authors and Affiliations

Goh Teik Chiang, Teo Khai Ling, Saw Xue Yi

Keywords

Spinal tuberculosis Paraplegia Cardiopulmonary dysfunction Neonate TB spine Spondylodiscitis Vertebral osteomyelitis Hematogenous M tuberculosis Dense vasculature Acute kyphosis

EP ID EP592315
DOI 10.26717/BJSTR.2018.10.001952
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