Extrapulmonary tuberculosis: a debilitating and often neglected public health problem

Abstract

We report a case of a 33-year-old woman from Nepal who presented to a hospital with paraplegia. She was found to have pulmonary tuberculosis (TB) with lumbar spine involvement, and bilateral psoas abscesses. She had no initial symptoms attributable to pulmonary involvement. Her delayed presentation to the hospital led to complication of TB spine, which compromised the life of this woman working as a labourer. Early diagnosis and treatment of extrapulmonary TB is essential. Awareness regarding symptoms of different forms of extrapulmonary TB and making diagnostic modalities such as CT scan, MRI or biopsy readily available through insurance schemes are some important measures to minimise the problem so that complications like paraplegia as in our patient with spinal TB can potentially be avoided.

Keywords: bone and joint infections; global health; tb and other respiratory infections; tropical medicine (infectious disease).

Figure 1

X-ray lumbosacral spine showing L2 compression with involvement of L1–L2 paradiscal area.

Figure 2

Chest X-ray showing bilateral heterogeneous opacities with right upper lobe cavitary lesion.

Figure 3

MRI of spine showing spondylodiscitis at L1–L2 level with soft tissue component markedly compromising the central spinal canal, along with bilateral psoas abscess.

Figure 4

X-ray lumbosacral spine after decompression of spinal canal and posterior instrumentation with laminectomy.