Journal of Mahatma Gandhi University of Medical Sciences and Technology

Register      Login

VOLUME 2 , ISSUE 2 ( 2017 ) > List of Articles

CASE REPORT

Spinal Intramedullary Tubercular Abscess

Jitendra Singh, Yogesh Agrawal, Ruchi Agrawal, Bhawani S Sharma

Keywords : Intramedullary tuberculosis, Spinal cord tuberculosis, Tubercular abscess

Citation Information : Singh J, Agrawal Y, Agrawal R, Sharma BS. Spinal Intramedullary Tubercular Abscess. J Mahatma Gandhi Univ Med Sci Tech 2017; 2 (2):102-105.

DOI: 10.5005/jp-journals-10057-0045

License: CC BY-NC-ND 3.0

Published Online: 00-08-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction Spinal intramedullary tubercular abscess is an extremely rare entity. Only few cases are reported in published literature. Case report A 30-year-old female with known case of pulmonary tuberculosis taking antitubercular treatment (ATT) for the last 6 months presented with back pain and progressive paraparesis. Her magnetic resonance imaging (MRI) dorsolumbar spine was suggestive of intramedullary abscess at D3 to D7 vertebrae level; she underwent D2 to D7 laminectomy and evacuation of pus and, subsequently, acid-fast bacilli (AFB) staining and pus culture. Mycobacterium tuberculosis was seen in both staining and culture of pus. Patient had shown signs of improvement and was discharged on 7th postoperative day. Conclusion In tuberculosis abscess, if the patient does not respond to medical management, and if progressive neurological deficit is present, surgery should be done for a definite histological diagnosis and decompression. How to cite this article Agrawal Y, Agrawal R, Sharma V, Singh J, Gupta P, Sharma BS. Spinal Intramedullary Tubercular Abscess. J Mahatma Gandhi Univ Med Sci Tech 2017;2(2):102-105.


PDF Share
  1. Hoda MF, Prasad R, Singh VP, Maurya P, Singh K, Sharma V. Spinal intramedullary tubercular abscess. Indian J Tuberc 2005;52:211-214.
  2. Hart J. Case on encysted abscess in the center of the spinal cord. Dublin Hosp Rep. 1830;5:522-524.
  3. Tacconi L, Arulampalam T, Johnston FG, Thomas DG. Intramedullary spinal cord abscess: case report. Neurosurgery 1995 Oct;37(4):817-819.
  4. Ditullio MV. Intramedullary spinal cord abscess: a case report with review of 53 previously described cases. Surg Neurol 1997 Jun;7(6):351-354.
  5. Tewari MK, Devi BI, Thakur RC, Pathak A, Khandelwal N, Kak VK. Intramedullary spinal cord abscess; a case report. Childs Nerv Syst 1992 Aug;8(5):290-291.
  6. Natesan S, Raghvendran R, Narasimman V, Kunjithapatham D. Spinal intramedullary tubercular abscess. J Spinal Surg 2014 Jan-Mar;1(1):39-40.
  7. Murthy JM. Tuberculous meningitis: the challenges. Neurol India 2010;58(5):716-722.
  8. Iademarco MF, Castro KG. Epidemiology of tuberculosis. Semin Respir Infect 2003 Dec;18(4):225-240.
  9. Garg RK. Tuberculosis of the central nervous system. Postgrad Med J 1999 Mar;75(881):133-140.
  10. Lin TH. Intramedullary tuberculoma of the spinal cord. J Neurosurg 1960 May;17:497-499.
  11. MacDonell AH, Baird RW, Bronze MS. Intramedullary tuberculoma of the spinal cord: case report and review. Rev Infect Dis 1990 May-Jun;12(3):432-439.
  12. Ratliff JK, Connolly ES. Intramedullary tuberculoma of the spinal cord: case report and review of the literature. J Neurosurg 1999 Jan;90(Suppl 1):125-128.
  13. Tureyen K. Tuberculoma of the conus medullaris: case report. Neurosurgery 2002 Mar;50(3):651-653.
  14. Rhoton EL, Ballinger WE, Quisling R, Sypert GW. Intramedullary spinal tuberculoma. Neurosurgery 1988 Apr;22(4):733-736.
  15. Tanriverdi T, Kizilkiliç O, Hanci M, Kaynar MY, Unalan H, Oz B. Atypical intradural spinal tuberculosis: report of three cases. Spinal Cord 2003 Jul;41(7):403-409.
  16. Hanci M, Sarioglu AC, Uzan M, Işlak C, Kaynar MY, Oz B. Intramedullary tuberculous abscess: a case report. Spine 1996 Mar;21(6):766-769.
  17. Desai KI, Muzumdar DP, Goel A. Holocord intramedullary abscess: an unusual case with review of literature. Spinal Cord 1999 Dec;37(12):866-870.
  18. Khalid M, Khalid S, Mittal S, Ahmad U. Intramedullary tubercular abscess with syrinx formation. J Pediatr Neurosci 2012 Feb;7:61-63.
  19. Woolsey RM, Chambers TJ, Chung HD, McGarry JD. Mycobacterial meningomyelitis associated with human immunodeficiency virus infection. Arch Neurol 1988 Jun;45(6):691-693.
  20. Devi BI, Chandra S, Mongia S, Chandramouli BA, Sastry KVR, Shankar SK. Spinal intramedullary tuberculoma and abscess: a rare cause of paraparesis. Neurol India 2002;50(4):494-496.
  21. Kumar R, Pandey CK, Bose N. Tubercular brain abscess; clinical presentation pathophysiology and treatment in children. Childs Nerv Syst 2002 Apr;18(3-4):118-123.
  22. Babu ML, Shavinder MCh. Tubercular brain abscess tubercular abscess; a diagnostic challenge. JK Practitioner 2002;9(4):262-264.
  23. Whitner DR. Tubercular brain abscess report of a case and review of literature. Arch Neurol 1978 Mar;35(3):148-155.
  24. Sinh G, Pandya SK, Dasture DK. Pathogenesis of unusual intracranial tuberculoma and tubercular space occupying lesion. J Neurosurg 1968 Aug;29(2):149-159.
  25. Ramdurg SR, Gupta DK, Suri A, Sharma BS, Mahapatra AK. Spinal intramedullary tuberculosis: a series of 15 cases. Clin Neurol Neurosurg 2009 Feb;111(2):115-118.
  26. Bommakanti K, Alugolu R, Chittem LR, Patil M, Purohit AK. Fulminant holocord intramedullary tubercular abscess with enigmatic presentation. Surg Neurol Int 2013 Mar;4:32.
  27. Shen WC, Cheng TY, Lee SK, Ho YJ, Lee KR. Disseminated tuberculomas in spinal cord and brain demonstrated by MRI with Gadolinium-DTPA. Neuroradiology 1993 Jan;35(3):213-215.
  28. Garg G, Singh S. Intramedullary spinal tuberculoma. Br J Neurosurg 2002;16:75-76.
  29. Rao GP. Spinal intramedullary tuberculous lesion: medical management. Report of four cases. J Neurosurg 2000;93(Suppl 1):137-141.
  30. Jena A, Banerji AK, Tripathi RP, Gulati PK, Jain RK, Khushu S, Sapra ML. Demonstration of intramedullary tuberculomas by magnetic resonance imaging: a report of two cases. Br J Radiol 1991;64(762):555-558.
  31. Citow JS, Ammirati M. Intramedullary tuberculoma of the spinal cord: case report. Neurosurgery 1994 Aug;35(2):327-330.
  32. Medhi S, Goswami B, Das AK, Singh TB, Husain SA, Sehgal A, Kar P. New insights into hepatitis C virus infection in the tribal-dominant part of Northeast India. Arch Virol 2012 Nov;157(11):2083-2093.
  33. Raghuraman S, Abraham P, Sridharan G, Ramakrishna BS. Hepatitis C virus genotype 6 infection in India. Indian. J Gastroenterol 2005 Mar-Apr;24(2):72-75.
  34. Raghuraman S, Abraham P, Sridharan G, Daniel HD, Ramakrishna BS, Shaji RV. HCV genotype 4 — an emerging threat as a cause of chronic liver disease in Indian (south) patients. J Clin Virol 2004 Dec;31(4):253-258.
  35. Umer M, Iqbal M. Hepatitis C virus prevalence and genotype distribution in Pakistan: comprehensive review of recent data. World J Gastroenterol 2016 Jan;22(4):1684-1700.
  36. Esmaeilzadeh A, Erfanmanesh M, Ghasemi S, Mohammadi F. Serological assay and genotyping of hepatitis C virus in infected patients in Zanjan province. Hepat Mon 2014 Sep;14(9):e17323.
  37. Mittal G, Gupta P, Gupta R, Ahuja V, Mittal M, Dhar M. Seroprevalence and risk factors of hepatitis B and hepatitis C virus infections in Uttarakhand, India. J Clin Exp Hepatol 2013 Dec;3(4):296-300.
  38. Sarma MP, Asim M, Medhi S, Bharathi T, Diwan R, Kar P. Viral genotypes and associated risk factors of hepatocellular carcinoma in India. Cancer Bio Med 2012 Sep;9(3):172-181.
  39. Ullah, Mi Hasan, F Najmudin, Alam, MM SSZZ, Rana, MS Nawaz, M Rehman S and Shah A A. Seroprevalence of Hepatitis C Virus Infection in Kohat Division, Khyber Pakhtoonkhwa, Pakistan. Pakistan J Zool 2016;.48(6):1721-1725.
  40. Ramarokoto CE, Rakotomanana F, Ratsitorahina M, Raharimanga V, Razafindratsimandresy R, Randremanana R, Rakoto-Andrianarivelo M, Rousset D, Andrianaja V, Richard V, et al. Seroprevalence of hepatitis C and associated risk factors in urban areas of Antananarivo, Madagascar. BMC Infect Dis 2008 Feb;8:25.
  41. Singh P, Kaur R, Kaur A. Frequency distribution of Hepatitis C virus in different geographical regions of Punjab: retrospective study from a tertiary care centre in North India. J Nat Sci Biol Med 2014 Jan;5(1):56-58.
  42. Sandhu R, Dahiya S. Prevalence of anti-hepatitis C virus antibodies among inpatients and outdoor attendees of a tertiary care institute. Br Biomed Bull 2015 Jan;3(1):8-14.
  43. Da Ros CT, Schmitt CdaS. Global epidemiology of sexually transmitted diseases. Asian J Androl 2008 Jan;10(1): 110-114.
  44. Te HS, Jensen DM. Epidemiology of hepatitis B and C viruses: a global overview. Clin Liver Dis 2010 Feb;14(1):1-21.
  45. Khan IA, Pilli S A S, Rampal R, Chauhan SK, Tiwari V, Mouli VP, Kedia S, Nayak B, Das P, Makharia GK, et al. Prevalence and Association of Mycobacterium avium subspecies paratuberculosis with disease course in patients with ulcero-constrictive ileocolonic disease. PLoS One 2016 Mar;11(3):e0152063.
  46. Ramadass B, Chittaranjan S, Subramanian V, Ramakrishna BS. Fecal polymerase chain reaction for Mycobacterium tuberculosis IS6110 to distinguish Crohn's disease from intestinal tuberculosis. Indian J Gastroenterol 2010 Jul;29(4):152-156.
  47. Jin XJ, Kim JM, Kim HK, Kim L, Choi SJ, Park IS, Han JY, Chu YC, Song JY, Kwon KS, et al. Histopathology and TB-PCR kit analysis in differentiating the diagnosis of intestinal tuberculosis and Crohn's disease. World J Gastroenterol 2010 May;16(20):2496-2503.
  48. Jin T, Fei B, Zhang Y, He X. The diagnostic value of polymerase chain reaction for Mycobacterium tuberculosis to distinguish intestinal tuberculosis from Crohn's disease: a meta-analysis. Saudi J Gastroenterol 2017 Jan-Feb;23(1):3-10.
  49. Sechi LA, Mura M, Tanda F, Lissia A, Solinas A, Fadda G, Zanetti S. Identification of Mycobacterium avium subsp. paratuberculosis in biopsy specimens from patients with Crohn's disease identified by in situ hybridization. J Clin Microbiol 2001 Dec;39(12):4514-4517.
  50. Sechi LA, Mura M, Tanda E, Lissia A, Fadda G, Zanetti S. Mycobacterium avium sub. paratuberculosis in tissue samples of Crohn's disease patients. New Microbiol 2004 Jan;27(1):75-77.
  51. Sechi LA, Scanu AM, Molicotti P, Cannas S, Mura M, Dettori G, Fadda G, Zanetti S. Detection and Isolation of Mycobacterium avium subspecies paratuberculosis from intestinal mucosal biopsies of patients with and without Crohn's disease in Sardinia. Am J Gastroenterol 2005 Jul;100(7):1529-1536.
  52. Pulimood AB, Peter S, Rook GW, Donoghue HD. In situ PCR for Mycobacterium tuberculosis in endoscopic mucosal biopsy specimens of intestinal tuberculosis and Crohn disease. Am J Clin Pathol 2008 Jun;129(6):846-851.
  53. Aimaiti R, Qin L, Cao T, Yang H, Wang J, Lu J, Huang X, Hu Z. Identification and application of ssDNA aptamers against H37Rv in the detection of Mycobacterium tuberculosis. Appl Microbiol Biotechnol 2015 Nov;99(21):9073-9083.
  54. Mozioglu E, Gokmen O, Tamerler C, Kocagoz ZT, Akgoz M. Selection of nucleic acid aptamers specific for Mycobacterium tuberculosis. Appl Biochem Biotechnol 2016 Feb;178(4):849-864.
  55. Tang XL, Wu SM, Xie Y, Song N, Guan Q, Yuan C, Zhou X, Zhang XL. Generation and application of ssDNA aptamers against glycolipid antigen ManLAM of Mycobacterium tuberculosis for TB diagnosis. J Infect 2016 May;72(5):573-586.
  56. Pan Q, Wang Q, Sun X, Xia X, Wu S, Luo F, Zhang XL. Aptamer against mannose-capped lipoarabinomannan inhibits virulent Mycobacterium tuberculosis infection in mice and rhesus monkeys. Mol Ther 2014 May;22(5):940-951.
  57. Perkins AC, Missailidis S. Radiolabelled aptamers for tumour imaging and therapy. Q J Nucl Med Mol Imaging 2007 Dec;51(4):292-296.
  58. Calzada V, Moreno M, Newton J, González J, Fernández M, Gambini JP, Ibarra M, Chabalgoity A, Deutscher S, Quinn T, et al. Development of new PTK7-targeting aptamer-fluorescent and radiolabelled probes for evaluation as molecular imaging agents: lymphoma and melanoma in vivo proof of concept. Bioorg Med Chem 2016 Dec;25(3):1163-1171.
  59. Lele, RD. Imaging tuberculosis with radiolabelled aptamers. In: Kulkarni SV, editor. Pursuit of excellence—an autobiography. Mumbai: Granthali Woollen Mill Public School; 2017. pp. 154-156.
  60. Fogel R, Limson J. Developing biosensors in developing countries: South Africa as a case study. Biosensors (Basel) 2016 Feb;6(1):E5.
  61. Chen F, Zhou J, Luo F, Mohammed AB, Zhang XL. Aptamer from whole-bacterium SELEX as new therapeutic reagent against virulent Mycobacterium tuberculosis. Biochem Biophys Res Commun 2007 Jun;357(3):743-748.
  62. Baig IA, Moon JY, Lee SC, Ryoo SW, Yoon MY. Development of ssDNA aptamers as potent inhibitors of Mycobacterium tuberculosis acetohydroxy acid synthase. Biochim Biophys Acta 2015 Oct;1854(10 Pt A):1338-1350.
  63. Sohal JS, Sheoran N, Narayanasamy K, Brahmachari V, Singh S, Subodh S. Genomic analysis of local isolate of Mycobacterium avium subspecies paratuberculosis. Vet Microbiol 2009 Mar;134(3-4):375-382.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.