Tuberculous Spondylitis. Burden of Diagnosis. Case Presentation

Abstract

Introduction: Tuberculosis continues to pose a problem of public health worldwide. Mycobacterium tuberculosis infects 1/3 of the world's population and seems to be responsible for 1.4 million deaths annually. In our country, the incidence is 6.5 times higher than in the EU countries. In 2016 there were 12836 cases of pulmonary TB (new and recurrent cases) of which 530 cases were TB MDR/XDR. The screening rate increased to 94% for new cases and 85% for MDR tuberculosis cases. Extrapulmonary tuberculosis remains a challenge by delaying of the diagnosis and the duration of treatment.Case presentation: We present the case of a 73-year-old patient with no significant pathological history admitted to the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, in July 2017 (21 days) for myalgia and fever apparently after an episode of a respiratory tract infection. Due to myalgia, the occurrence of muscular atrophy and accelerate weight loss he referred to our hospital where was established the diagnosis of Tuberculous Spondylitis.Results and methods: The diagnosis was established following numerous clinical and paraclinical investigations approximately 6 weeks after the first presentation to our hospital. As risk factors, the patient was diagnosed by the time of admission with other diseases that he wasn’t aware of as diabetes and renal impairment. Evolution under anti-tuberculosis treatment was arduous due to the development of hepatic toxicity, episodes of acute exacerbation of chronic renal disease and post-antibiotic diarrhoea. The final clinical and paraclinical outcome was favourable.Discussion: Diagnosis of TB spondylitis requires both multidisciplinary collaborations and diagnosis experience. Anamnesis and understanding of symptoms are also important for proper selecting paraclinical tests panel. To understand these results in view of imposing a nephrotoxic and hepatotoxic treatment in the patient with pre-existing liver and kidney pathology, we returned to understanding the pathophysiology of Tuberculous Spondylitis.Conclusions: Diagnosing the vertebral location of extrapulmonary tuberculosis requires understanding pathophysiology of this infection. Requesting of paraclinical investigation and performing differential diagnostics can help shorten the time required for diagnosis.