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  • Multi-focal TB Misdiagnosed as Paraplegia

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    bhongskirn
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    This document describes the case of a 21-year-old female who was admitted with a diagnosis of paraplegia but was ultimately found to have tuberculosis (TB) affecting multiple areas including her spine, lungs, lymph nodes, breast, and brain. She had experienced progressively worsening symptoms over three years. After starting empirical anti-TB treatment, imaging revealed TB lesions in her thoracic spine as well as other sites. She was referred to a neurosurgeon and treatment with anti-TB drugs led to resolution of her fever. The case demonstrates that paraplegia should not be considered a diagnosis on its own, as the patient was found to have the potentially curable disease of TB which had gone untreated for years.

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    Paraplegia

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    Paraplegia

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    This document describes the case of a 21-year-old female who was admitted with a diagnosis of paraplegia but was ultimately found to have tuberculosis (TB) affecting multiple areas including her spine, lungs, lymph nodes, breast, and brain. She had experienced progressively worsening symptoms over three years. After starting empirical anti-TB treatment, imaging revealed TB lesions in her thoracic spine as well as other sites. She was referred to a neurosurgeon and treatment with anti-TB drugs led to resolution of her fever. The case demonstrates that paraplegia should not be considered a diagnosis on its own, as the patient was found to have the potentially curable disease of TB which had gone untreated for years.

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    © All Rights Reserved
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    34 views8 pages

    Multi-focal TB Misdiagnosed as Paraplegia

    Uploaded by

    bhongskirn
    This document describes the case of a 21-year-old female who was admitted with a diagnosis of paraplegia but was ultimately found to have tuberculosis (TB) affecting multiple areas including her spine, lungs, lymph nodes, breast, and brain. She had experienced progressively worsening symptoms over three years. After starting empirical anti-TB treatment, imaging revealed TB lesions in her thoracic spine as well as other sites. She was referred to a neurosurgeon and treatment with anti-TB drugs led to resolution of her fever. The case demonstrates that paraplegia should not be considered a diagnosis on its own, as the patient was found to have the potentially curable disease of TB which had gone untreated for years.

    Copyright:

    © All Rights Reserved
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    of 8

    http:dx.doi.org/10.1016/i-jmyco-2012.07.

    008 Chest con April 2014 Islamabad

    Paraplegia is not a diagnosis

    • Back ground knowledge


    • TB remains an emerging global health problem.
    • Skeletal involvement occurs in approximately 10% all patients with
    extra-pulmonary TB, with 50% spine involvement.
    • Multifocal Tb is characterized by presence of large multifocal
    tuberculous areas in the different adjacent or distant organs.
    • Diagnosis is delayed due to insidious nature, lack of anticipation and
    difficulty in confirmation of the diagnosis or
    • Initiating empirical antiTB treatment with very devastating and
    often irreversible complications.

    1
    http:dx.doi.org/10.1016/i-jmyco-2012.07.008 Chest con April 2014 Islamabad
    .

    Paraplegia is not a diagnosis

    • Case report: of 21 year female admitted for rehablitation running


    temperature.
    • Known to have corpus callosum atrophy, poor psychosocial
    development and epilepsy.
    • Admitted with diagnosis of Paraplegia ,double incontinence,
    intractable seizures, inability to stand and walk since 3 years, before
    which she was ambulant.

    2
    http:dx.doi.org/10.1016/i-jmyco-2012.07.008 Chest con April 2014 Islamabad

    Paraplegia is not a diagnosis

    • Corpus callosum atrophy--- diagnosed at age 3 years ,


    • after poor psychosocial development
    • Epilepsy Bed ridden— at age 6 years
    • Double incontinent.
    • Fever since long
    • Severe constipation 1 month
    • Intractable seizures since 3 months
    • Booking weight 58.5 kg { h/o weight loss 5 kg in last 2 years}

    3
    http:dx.doi.org/10.1016/i-jmyco-2012.07.008

    Paraplegia is not a diagnosis

    • Physical examination
    • T=37.8, BP= 110/70, HR=88 , RR= 20, O2 sat= 97% , weight=58.5 kg
    • Fully alert, shy feeble minded low IQ.
    • Pallor+
    • Palpable Gibbus at lower back of chest thoracic spine.
    • Left breast nodule
    • Power lower limbs 0-1/5, up going planters.
    • Upper limbs normal
    • Double incontinent---managed by diapers.

    4
    http:dx.doi.org/10.1016/i-jmyco-2012.07.008 Chest con April 2014 Islamabad

    Paraplegia is not a diagnosis

    • Chest x-ray --- figure


    • CT abdomen & chest (without contrast) ---figures
    • Bronchoscopy--figure
    • Sputum & BAL D/S AFB ,Mycobacterial C/S
    • PPD figure-
    • ESR
    • CBC, CRP
    • CT brain ----- figure- done after starting empirical antiTB treatment to
    exclude brain involvement.
    • MRI spine & pelvis---- figure----done after referral to neuro-spinal surgeon.

    5
    http:dx.doi.org/10.1016/i-jmyco-2012.07.008 Chest con April 2014 Islamabad

    Paraplegia is not a diagnosis

    • Admitted via Physiatry OPD for rehabilitation


    • Internal medicine back up consultation
    • Surgical consultation
    • Neurological consultation
    • Infectious diseases & Pulmonary consultation
    • Started empirical antiTB treatment.
    • CT brain-------
    • Neurosurgical consultation & referral
    • Final diagnosis: Corpus callosal atrophy, epilepsy, Pulmonary &
    extra pulmonary TB(brain, Thoracic spine, paraaortic
    lymphadenopathy,left breast, fallopian tubes).

    6
    http:dx.doi.org/10.1016/i-jmyco-2012.07.008

    Paraplegia is not a diagnosis

    • antiTB
    • Tab.INH 300 mg po od
    • Tab.Riampicin 600 mg po od
    • Tab.Pyrazinamide 1500 mg po od
    • Tab.Ethambutol 1200 mg po od
    • Tab.Vit B6 40 mg po od
    • Adjuvant steroids
    • Inj.clexane 40 mg sc od
    • 3 antiepileptic drugs----- Tab.Valproate (depaqene) 500 mg po
    od,Tab.Lamictal -------, Tab.Tegretal ----- could be tapered gradually
    to 2 within 3 weeks.

    7
    http:dx.doi.org/10.1016/i-jmyco-2012.07.008

    Paraplegia is not a diagnosis


    Course in the hospital
    Tolerated treatment well & transfer to KFSH
    Fever resolved in 2 weeks time.
    Referral to the neuro-spinal surgeon as GATA-iii-Pott’s disease is a
    therapeutic and prognostic urgency.
    Classification of Pott’s disease
    • i
    • ii
    • Iii
    • Post surgery x-rays---- figure.
    Histopathology proved ---TB at KFSH.
    Conclusion: A potentially curable disease if diagnosed & treated early
    will have excellent outcomes without associated morbidity and
    irreversible complications.

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