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Back pain: An old cause in a young adult

  • Barbara Ferrari
    Correspondence
    Corresponding author at: Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Milan, Italy. Via Pace 9, 20122 Milan, Italy. Tel.: +39 02 5503 5414, fax; +39 02 54 100 125.
    Affiliations
    Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Milan, Italy
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  • Raffaella Rossio
    Affiliations
    Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Milan, Italy
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  • Flora Peyvandi
    Affiliations
    Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Milan, Italy
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Published:February 17, 2015DOI:https://doi.org/10.1016/j.ejim.2015.02.002

      Highlights

      • We describe a case of Pott's disease.
      • Skeletal tuberculosis should be considered in the differential diagnosis of spine masses.
      • The images provided are typical and may help to improve clinicians' knowledge.

      1. Indication

      A 23-year-old man from the Philippines was admitted to our emergency department for a three-weeks-lasting thoracic back pain, followed by an onset of postural instability; he also complained about repeated alternation of constipation and diarrhoea, associated with burning abdominal pain. On physical examination, the patient showed ataxic gait, a T10 spinal sensory level and symmetric hyperreflexia at lower limbs. A magnetic resonance imaging (MRI) scan of the spine was performed and revealed the collapse of the ninth thoracic vertebral body and a pathologic mass invading the spinal canal with spinal cord compression (Fig. 1).
      Figure thumbnail gr1
      Fig. 1Spine mass with collapse of the ninth thoracic vertebral body and presence of pathologic mass invading the spinal canal with spinal cord compression, by magnetic resonance imaging (MRI) scan of the spine (Panel A and B).
      What is the diagnosis?

      2. Diagnosis

      The patient underwent surgery for decompression and dorsal arthrodesis to stabilize the spine. The extemporaneous histologic examination of the mass revealed a giant-cell granulomatous chronic inflammation, focally necrotizing. After rapid detection of Mycobacterium tuberculosis complex DNA on the biopsy tissue by polymerase chain reaction, anti-tuberculous therapy was started. Culture tests confirmed the diagnosis. At the last follow-up, two months after discharge, patient's conditions are good and neurological examination normal.
      Despite socio-economic improvement in western countries and availability of effective drugs, the impact of acquired immunodeficiency syndrome and immigration has increased the rate of tuberculosis. Spinal tuberculosis (Pott's disease) is the most common extra-pulmonary manifestation of tuberculosis. The thoracic segment is the most frequently affected spinal segment, followed by the lumbar spine [
      • Fuentes Ferrer M.
      • Gutiérrez Torres L.
      • Ayala Ramírez O.
      • Rumayor Zarzuelo M.
      • del Prado González N.
      Tuberculosis of the spine. A systematic review of case series.
      ]. Imaging tests such as MRI and computed tomography help in diagnosing the disease but microbiological diagnosis based on culture and/or histology techniques is indicated for definitive diagnosis [
      • Trecarichi E.M.
      • Di Meco E.
      • Mazzotta V.
      • Fantoni M.
      Tuberculous spondylodiscitis: epidemiology, clinical features, treatment and outcome.
      ].
      Spinal tuberculosis is a great challenge to physicians due to the wide non-specific spectrum of clinical presentations, which result in delay of diagnosis and the risk of significant potential morbidity and mortality due to several complications (i.e. paraplegia). Early diagnosis and treatment are the keys to avoid this long-term disability [
      • Ansari S.
      • Amanullah M.F.
      • Ahmad K.
      • Rauniyar R.K.
      Pott's spine: diagnostic imaging modalities and technology advancements.
      ]. Therefore, spinal tuberculosis should be considered as a differential diagnosis in patients with chronic back pain and neurological symptoms, especially if coming from endemic areas.

      Conflict of interest

      None.

      Appendix A. Supplementary data

      References

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