Cargando…

Tuberculous lumbar spinal epidural abscess in a young adult (case report)

Introduction: Spinal Epidural abscess (SEA) is an uncommon pathology that needs an urgent intervention to decompress the pressure on the spinal epidural sac, cord, and roots. The authors report a rare case of a young adult with lumbar spinal epidural tuberculous abscess occupying the spinal canal fr...

Descripción completa

Detalles Bibliográficos
Autores principales: Hasan, Ghazwan Abdulla, Kani, Saif Mohammed, Alqatub, Ahmed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: EDP Sciences 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844233/
https://www.ncbi.nlm.nih.gov/pubmed/29521260
http://dx.doi.org/10.1051/sicotj/2018005
_version_ 1783305217637351424
author Hasan, Ghazwan Abdulla
Kani, Saif Mohammed
Alqatub, Ahmed
author_facet Hasan, Ghazwan Abdulla
Kani, Saif Mohammed
Alqatub, Ahmed
author_sort Hasan, Ghazwan Abdulla
collection PubMed
description Introduction: Spinal Epidural abscess (SEA) is an uncommon pathology that needs an urgent intervention to decompress the pressure on the spinal epidural sac, cord, and roots. The authors report a rare case of a young adult with lumbar spinal epidural tuberculous abscess occupying the spinal canal from L2–L5 vertebrae with extesion to the posterior paraspinal muscles and presenting with bilateral progressive lower limb weakness.   Case report: A 42 years old male teacher presented with a 15-day history of progressive difficulty to walking and bilateral lower limb weakness associated with fever, malaise and later on urinary incontinence. A magnetic resonance imaging (MRI) scan revealed a paraspinal intermuscular abscess and an abscess occupying the spinal canal compressing the dural sac from L2–L4/5, without any signs of vertebral involvement. Surgery was done by a posterior midline incision. Pus was evacuated from multiple pockets through the paraspinal muscle layers. Laminectomy for L3/4, and hemilaminectomy for L2/3, and L4/5 were performed. Pus and bone specimens were negative for acid-fast bacilli. However, both histopathological studies and Polymerase Chain Reaction (PCR) testing confirmed the presence of tuberculosis (TB). The patient received TB antibiotics, and a follow-up MRI scan at 2 months showed complete evacuation of the abscess. However, signs of L5 spondylitis were evident. No further surgery was needed as there was no vertebral collapse or neural compression and the patient's clinical condition was improving. He had normal right lower limb power and sensation and grade 4+ motor power of the left lower limb. Bowels and bladder function was normal. Conclusion: Isolated tuberculous spinal epidural abscess is a rare disease and should be treated urgently with evacuation and decompression. Signs of spondylitis or spondylodiscitis may appear later and therefore long follow up is recommended in tuberculous cases presenting with an isolated epidural abscess.
format Online
Article
Text
id pubmed-5844233
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher EDP Sciences
record_format MEDLINE/PubMed
spelling pubmed-58442332018-03-14 Tuberculous lumbar spinal epidural abscess in a young adult (case report) Hasan, Ghazwan Abdulla Kani, Saif Mohammed Alqatub, Ahmed SICOT J Case Report Introduction: Spinal Epidural abscess (SEA) is an uncommon pathology that needs an urgent intervention to decompress the pressure on the spinal epidural sac, cord, and roots. The authors report a rare case of a young adult with lumbar spinal epidural tuberculous abscess occupying the spinal canal from L2–L5 vertebrae with extesion to the posterior paraspinal muscles and presenting with bilateral progressive lower limb weakness.   Case report: A 42 years old male teacher presented with a 15-day history of progressive difficulty to walking and bilateral lower limb weakness associated with fever, malaise and later on urinary incontinence. A magnetic resonance imaging (MRI) scan revealed a paraspinal intermuscular abscess and an abscess occupying the spinal canal compressing the dural sac from L2–L4/5, without any signs of vertebral involvement. Surgery was done by a posterior midline incision. Pus was evacuated from multiple pockets through the paraspinal muscle layers. Laminectomy for L3/4, and hemilaminectomy for L2/3, and L4/5 were performed. Pus and bone specimens were negative for acid-fast bacilli. However, both histopathological studies and Polymerase Chain Reaction (PCR) testing confirmed the presence of tuberculosis (TB). The patient received TB antibiotics, and a follow-up MRI scan at 2 months showed complete evacuation of the abscess. However, signs of L5 spondylitis were evident. No further surgery was needed as there was no vertebral collapse or neural compression and the patient's clinical condition was improving. He had normal right lower limb power and sensation and grade 4+ motor power of the left lower limb. Bowels and bladder function was normal. Conclusion: Isolated tuberculous spinal epidural abscess is a rare disease and should be treated urgently with evacuation and decompression. Signs of spondylitis or spondylodiscitis may appear later and therefore long follow up is recommended in tuberculous cases presenting with an isolated epidural abscess. EDP Sciences 2018-03-09 /pmc/articles/PMC5844233/ /pubmed/29521260 http://dx.doi.org/10.1051/sicotj/2018005 Text en © The Authors, published by EDP Sciences, 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Hasan, Ghazwan Abdulla
Kani, Saif Mohammed
Alqatub, Ahmed
Tuberculous lumbar spinal epidural abscess in a young adult (case report)
title Tuberculous lumbar spinal epidural abscess in a young adult (case report)
title_full Tuberculous lumbar spinal epidural abscess in a young adult (case report)
title_fullStr Tuberculous lumbar spinal epidural abscess in a young adult (case report)
title_full_unstemmed Tuberculous lumbar spinal epidural abscess in a young adult (case report)
title_short Tuberculous lumbar spinal epidural abscess in a young adult (case report)
title_sort tuberculous lumbar spinal epidural abscess in a young adult (case report)
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844233/
https://www.ncbi.nlm.nih.gov/pubmed/29521260
http://dx.doi.org/10.1051/sicotj/2018005
work_keys_str_mv AT hasanghazwanabdulla tuberculouslumbarspinalepiduralabscessinayoungadultcasereport
AT kanisaifmohammed tuberculouslumbarspinalepiduralabscessinayoungadultcasereport
AT alqatubahmed tuberculouslumbarspinalepiduralabscessinayoungadultcasereport