Lumbosacral and pulmonary tuberculosis

Case contributed by Dr Hamdy Mohammed Ibrahim

Presentation

This adult male , presented with spasm of the left lower limb with inability to extend it with ease, Ultrasound revealed a left psoas muscle collection. A pigtail catheter was inserted, the collection seems to be retroperitoneal pre-psoas with healthy psoas fibers and seen bilaterally. It retrieved serosanginous fluid. MSCT of the chest and abdomen was done and cytology with Zeil-Nelsen staining was requested; unfortunately the patient follow up was missed. This is compensated by known history of admission to chest hospital for TB course of treatment.

Patient Data

Age: 35 yrs
Gender: Male

Bilateral scattered pulmonary fibrocavitary lesions largest cavity seen at the right lung apex, the mediastinum studded with enlarged matted LNs show faint homogeneous enhancement, some of them show foci of calcification

Abnormal erosion and sclerosis of L4 and L5 opposing vertebral body end plates with increased intervening disc density as well as extension of the abnormal disc material i the epidural and prevertebral spaces, the latter seen trickled over the psoas muscle of each side.

Associated findings seen at the splenic periphery as  non enhanced patches in all phases consistent with infarction.

More or less similar lesion seen involving the anteroinferior segment of the left kidney with faint enhancement...it seems to be TB involvement rather than renal infarction.

Case Discussion

Lumbosacral TB is a rare site of spondylodiscitis, despite of rare incidence it behaves like usual TB spondylodiscitis regarding epidural fluid component  formation and neural compression but of milder form due to capacious spinal canal and thecal sac as well as the fewer number of cauda equina nerve roots....direct involvement of psoas muscles is rare as the muscle became slightly away from the spinal column at this distal position, so that pre psoas collection is the usual pathway for escape of the prevertebral fluid component of the disease....association of supportive findings of TB especially pulmonary and mediastinal affection and possible left renal involvement are strongly support the diagnosis as in our case..... we cannot outline the definite cause of the associated  possible splenic infarcts in this case....cytology and Zeil-Nelsen staining from the aspirate are strongly needed. 

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Case information

rID: 53494
Case created: 21st May 2017
Last edited: 22nd May 2017
Inclusion in quiz mode: Included

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