scholarly journals Mycobacterium xenopi osteomyelitis of the spine: a case report

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
Fred UN Ukunda
Keyword(s):  
Case Report ◽  
Spinal Tuberculosis ◽  
Vertebral Osteomyelitis ◽  
Granulomatous Inflammation ◽  
Cd4 Count ◽  
Nontuberculous Mycobacterium ◽  
Strain Identification ◽  
Thoracic Myelopathy ◽  
Thoracic Spinal ◽  
Mycobacterium Xenopi

ABSTRACT BACKGROUND: Mycobacterium xenopi (M. xenopi) osteomyelitis is an uncommon infection which is found in immunosuppressed patients. It is reported to be a slow-growing, nonchromogenic or scotochromogenic nontuberculous mycobacterium. The lungs constitute the most common site for infection and extrapulmonary manifestations, and disseminated forms of the disease are rare. Only a few cases of spontaneous spinal involvement have been reported. We report a case of M. xenopi vertebral osteomyelitis of the spine PATIENT AND METHODS: A 41-year-old female patient, HIV reactive on antiretroviral therapy with a low CD4 count of 183 cells/mm3, presented with clinical and radiological features in keeping with thoracic spinal tuberculosis, complicated with thoracic myelopathy. She was managed surgically with costo-transversectomy and drainage of the paraspinal cold abscess. The Ziehl-Neelsen staining was negative for acid-fast bacilli. However, the histology result revealed a necrotising granulomatous inflammation. A delayed result of polymerase chain reaction (PCR)/line probe assay for Mycobacterium genus testing revealed the presence of M. xenopi, as the cause for the spine osteomyelitis and thoracic myelopathy. However, no M. xenopi susceptibility testing, and no specific photoreactivity techniques for strain identification, were performed. Anti-tuberculosis therapy (ATT) consisting of a two-month initiation phase using rifampicin, isoniazid, ethambutol and pyrazinamide, followed by a seven-month continuation phase using rifampicin and isoniazid, was initiated according to national guidelines. She was fitted with a thoraco-lumbar-sacral orthosis, and underwent a spinal rehabilitation programme. Upon receipt of the PCR result, and considering the good clinical and radiological response to ATT, a consensus was reached with the Infectious Disease Unit (IDU) to continue with ATT until 18 months due to the atypical nature of the pathogen. RESULTS: The patient was successfully treated with the standard TB regimen, but for a period of 18 months, and made full clinical neurological recovery, without any back pain. Furthermore, her CD4 count had also improved to 707 cells/mm3 with a viral load reported lower than 1 000 copies/ml CONCLUSION: This case report emphasises the importance of biopsy in suspected spinal tuberculosis and highlights the concerns with laboratory testing and the prognostic and therapeutic implications of a positive strain identification Level of evidence: Level 5 Keywords: Mycobacterium xenopi osteomyelitis, tuberculosis, anti-tuberculosis treatment

scholarly journals Intramedullary Tuberculoma of the Spinal Cord: A Case Report

2020 ◽  
Vol 13 ◽  
pp. 300-303
Author(s):  
Kelsey Knobbe ◽  
Melissa Gaines
Keyword(s):  
Spinal Cord ◽  
Differential Diagnosis ◽  
Case Report ◽  
Treatment Guidelines ◽  
Clinical Course ◽  
Spinal Tuberculosis ◽  
Spot Test ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Spinal Lesion

Intramedullary tuberculoma (IMT) is a form of spinal tuberculosis which provides a challenge to the internist because there lacks clear diagnostic and treatment guidelines to date. Although rare, it should be included on the differential diagnosis of any patient who presents with progressively worsening symptoms of radiculopathy and a new spinal lesion on imaging. Traditional methods for detection of tuberculosis including tuberculosis spot test and the Ziehl-Neelsen stain have limited utility in diagnosing IMT. In this report, we describe the clinical course, diagnosis and treatment regimen of an adult male with intramedullary tuberculoma of the thoracic spinal cord

Spontaneous Herniation of the Thoracic Spinal Cord: A Case Report

2001 ◽  
Vol 45 (4) ◽  
pp. 353 ◽  
Author(s):  
Sung Chan Jin ◽  
Seoung Ro Lee ◽  
Dong Woo Park ◽  
Kyung Bin Joo
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Spontaneous Herniation

Recurrent Episodes of Pericardial Effusion as Isolated Manifestation of Tuberculosis: Case Report

2018 ◽  
Vol 15 (1) ◽  
pp. 78-80
Author(s):  
Oscar Westin ◽  
Abbas Ali Qayyum
Keyword(s):  
Case Report ◽  
Pericardial Effusion ◽  
Granulomatous Inflammation ◽  
Physical Contact ◽  
Tuberculosis Case ◽  
Chest X Ray ◽  
X Ray Computed ◽  
Polymerase Chain ◽  
Cytology Report ◽  
Biochemical Examination

Background: Recurrent episodes of isolated pericardial effusion due to tuberculosis, leading to reduced Left Ventricle Ejection Fraction (LVEF), are uncommon. Methods: This is a case report of a previously healthy 32-years old male with tuberculous induced pericardial effusion as isolated manifestation. The only known exposure of tuberculosis was a brother with whom the patient did not have physical contact during the last year. The pericardial effusion repeatedly appeared after being drained a total of three times. Due to recurrent episodes of pericardial effusion, severe thickening of the pericardium, pericardial adherences and increasing affection on the heart, pericardiectomy was ultimately performed. Results: Biochemical examination, chest X-ray, computed tomography of thorax and abdomen and cytology report did not reveal any signs of malignancy, connective tissue disease or other infections including extra-pulmonary/pulmonary tuberculosis. However, the pericardial biopsy was Polymerase Chain Reaction positive (PCR) for tuberculosis DNA and showed granulomatous inflammation with necrosis. After 6 months anti-tuberculous therapy, biochemical parameters, LVEF and the clinical condition of the patient were normalized. Conclusion: Tuberculosis can be difficult to diagnose when it only manifests as pericardial effusion especially if the time for exposure is long before the appearance of symptoms and admission.

scholarly journals A diffuse granulomatous inflammation secondary to a trauma of hand: a case report.

2021 ◽  
Vol 16 (8) ◽  
pp. 2256-2260
Author(s):  
Sui Zheng ◽  
Jiagang Wang ◽  
Zhongyuan Ji
Keyword(s):  
Case Report ◽  
Granulomatous Inflammation

scholarly journals Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Weiwei Li ◽  
Zheng Liu ◽  
Xiao Xiao ◽  
Zhenchao Xu ◽  
Zhicheng Sun ◽  
...  
Keyword(s):  
Blood Loss ◽  
Surgical Intervention ◽  
Spinal Tuberculosis ◽  
Thoracic Spinal ◽  
Cobb’S Angle ◽  
Perioperative Complication ◽  
The Mean ◽  
Early Surgical Intervention ◽  
Thoracic Spinal Tuberculosis

Abstract Background To explore the therapeutic effect of early surgical intervention for active thoracic spinal tuberculosis (TB) patients with paraparesis and paraplegia. Methods Data on 118 active thoracic spinal TB patients with paraparesis and paraplegia who had undergone surgery at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade and NASCIS score of neurological status rating, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects of surgery. Results The mean operating time was 194.2 minutes, and the mean blood loss was 871.2 ml. The perioperative complication rate was 5.9 %. The mean preoperative VAS score was 5.3, which significantly decreased to 3.2 after the operation and continued decreasing to 1.1 at follow up (P<0.05). All cases achieved an increase of at least one ASIA grade after operation. The rate of full neurological recovery for paraplegia (ASIA grade A and B) was 18.0 % and was significantly lower than the rate (100 %) for paraparesis (ASIA grade C and D) (P<0.05). On the NASCIS scale, the difference in the neurological improvement rate between paraplegia (22.2 % ± 14.1 % in sensation and 52.2 % ± 25.8 % in movement) and paraparesis (26.7 % ± 7.5 % in sensation and 59.4 % ± 7.3 % in movement) was remarkable (P<0.05). Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, respectively, which showed a significant increase after operation (P>0.05), then gradually decreased to 11.5 ± 1.8 mm/h and 2.6 ± 0.82 mg/L, respectively, at final follow up (P<0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, which significantly decreased to 6.5º after operation (P<0.05) while kyphotic correction was not lost during follow up (P>0.05). The mean duration of bone graft fusion was 8.6 ± 1.3 months. Conclusions Early surgical intervention may be beneficial for active thoracic spinal TB patients with paraparesis and paraplegia, with surgical intervention being more beneficial for recovery from paraparesis than paraplegia.

scholarly journals Percutaneous Epidural Hydrogel Sealant for the Treatment of Spontaneous Intracranial Hypotension: A Case Report of Chronic Thoracic Neuralgia and Technical Lessons Learned

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Michael G. Hillegass ◽  
Samuel F. Luebbert ◽  
Maureen F. McClenahan
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Lessons Learned ◽  
Injection Velocity ◽  
Thoracic Spinal Cord ◽  
Ct Guided ◽  
Thoracic Spinal ◽  
Needle Position

We report a case in which a 34-year-old female with refractory intracranial hypotension headaches due to a spontaneous dural tear was ultimately treated with CT-guided transforaminal epidural placement of a synthetic absorbable sealant (DuraSeal®). The procedure successfully resolved her headaches; however she subsequently developed thoracic neuralgia presumably due to mass effect of the sealant material on the lower thoracic spinal cord and nerve roots. This case report describes the potential for significant spinal cord and nerve root compression as well as the development of chronic neuralgia with the placement of epidural hydrogel and fibrin glue sealants. Careful consideration should be taken into the needle gauge, needle position, injectate volumes, and injection velocity when delivering the sealant to the epidural space. Use of an 18-gauge Tuohy needle with a slow but steady injection pressure, constant patient feedback, and a conservative injectate volume (less than 2 ml per level) may best optimize sealant delivery to minimize the risk of spinal cord compression and neurologic injury.

Sign in / Sign up

Export Citation Format

Share Document