Spinal presence of atypical clinical symptoms like LBP,

Spinal TB is a common disease in the
developing countries 6,7. Dorsolumbar spine is the common place of TB Spine
and the incidence on this place is about 95% and incidence on the cervical
spine is 5%.8

 

Sacral spine TB is
rare and large series has not been reported in the literature. The diagnosis of
the sacral spine TB is challenging for physicians, radiologists and spine
surgeons. Clinical assessment of the patients should start with a careful history
and a detailed physical examination. The clinical presentation can vary according
to the age, health status, site of infection, stage of the disease and the
absence or presence of abscesses, sinus tracts or neurological status. 9  The common presenting symptoms of the sacral
TB are non-speci?c pain and swelling. Sometime, the skeletal tuberculosis
frequently mimics neoplasia like chordoma and osteoclastoma leading to
incorrect initial diagnosis and delay in the institution of treatment. 10 CT and
Magnetic Resonance Imaging (MRI) scans are the choice of radiological
investigation. CT can reveal destructive lesions in the sacrum and the sacrum
cortex may be diffusely destroyed secondary to the lesion expansion. And the
MRI of the sacrum usually has a severe replacement of bone marrow, presenting
with a low signal intensity mass on T1-weighted images patients and on
T2-weighted images on spin echo sequences .11

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In this case, the
patient presented with low back pain (LBP) and aspiration confirmed the cold abscess.
The CT scan suggested the TB and the CT guided biopsy of the lesion proved the
sacral spine TB.  The patient was
referred to the TB clinic for ATT. After 18 months of ATT the repeat CT of the
sacral spine showed the healed lesion. The general condition of the patients
also improved a lot. The sacral spine TB was managed successfully.  Other literature also showed diagnosis by
biopsy and successful treatment of the sacral spine TB with ATT. 3,4,5,12

 

Isolated sacral tuberculosis is rare
but high degree of suspicion is needed in the presence of atypical clinical
symptoms like LBP, gluteal region swelling and patient suffering from DM. 

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