Concurrent Spinal Epidural Tubercular and Pyogenic Abscess of Cervical Spine without Bony Involvement

Abstract

Spinal epidural abscess (SEA) presents with vertebral body involvement. SEA is mostly pyogenic in developed countries, but in developing countries, tuberculosis is more common cause. Young female presented with fever, neck, and right upper limb pain for 1 month followed by acute onset weakness in the right upper limb. Magnetic resonance imaging study of cervical spine showed contrast-enhancing lesion in C2-C3 epidural region. Surgery-aided by initiation of antibacterial and antitubercular treatment based on culture and histopathological study of pus helped us to get good clinical outcome. One should always keep in mind possibility of tubercular abscess while treating cases of spinal epidural lesions, though it is rare in the absence of osseous involvement. Pyogenic and tubercular abscess can present concurrently and sending pus for culture and sensitivity is must as it plays important role in identifying dual organisms.

Keywords: Abscess; cervical; concurrent; epidural; isolated; pyogenic; spinal; tuberculosis.

Figure 1

Magnetic resonance imaging cervical spine sagittal and axial view showing C2–C3 anterior epidural lesion which is isointense on T1-weighted images (sagittal view a, axial view d), hyperintense on T2-weighted images (sagittal view b, axial view e). Lesion showing peripherally contrast enhancement with central hypointensity (sagittal view c, axial view f)

Figure 2

Computed tomography scan upper cervical spine; axial and sagittal views (a and b) showing no bony abnormality

Figure 3

Histological picture showing evidence of tuberculous inflammation

Figure 4

Postoperative magnetic resonance imaging cervical spine; sagittal, and axial T1 images (a and d), T2 images (b and e) and postcontrast images (c and f) showing no evidence of lesion at C2–C3 level