Tuberculous spondylitis

Case contributed by Assoc Prof Frank Gaillard

Patient Data

Age: 50
Gender: Male
CT

Destructive process involves the left side of the L5 vertebral body. The discs are relatively spared, compared to the degree of bony destruction. 

MRI

Destructive process involves the left side of the L5 vertebral body, with a non-enhancing fluid component laterally. The discs are relatively spared, compared to the degree of bony destruction. Only a small epidural component is present. 

 

Pathology

Histology

MICROSCOPIC DESCRIPTION:

The sections show necrotizing granulomatous inflammation with scattered nodular aggregates of epithelioid histiocytes and multinucleated giant cells. Necrosis is seen. The granulomas are surrounded by abundant lymphocytes. No tumor is identified. The Grocott stain shows no fungi. The Ziehl-Neelsen stain shows 2 acid fast bacilli.

DIAGNOSIS:

Spinal lesion: Necrotizing granulomatous inflammation with acid fast bacilli, in keeping with mycobacterial infection.

 

Microbiology

  • ANTIGEN TESTING (ON ISOLATE) MPT64
    • Antigen Identification Test: M.tuberculosis Complex DETECTED
  • MYCOBACTERIUM CULTURE SCREEN
    • MGIT bottle <13 days POSITIVE
  • MYCOBACTERIAL CULTURE
    • Acid Fast Bacilli ISOLATED 

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