Article Number: DRJHP17250423

DOI: https://doi.org/10.26765/DRJHP17250423

ISSN: 2449-0814

Vol.8 (6), pp. 80-93, October 2020

Copyright © 2020

Author(s) retain the copyright of this article


Case Study

Skipped Multifocal Extensive Pott’s Disease with Quadriplegia: A Rare Case Report and the Challenges of Management in our Environment

Bamidele Johnson Alegbeleye


Abstract

Objective: We are reporting unanticipated noncontiguous multifocal Pott’s disease involving the whole spine with quadriplegia. Therefore, the communique aimed to provide updated data on this critical atypical spinal TB and highlights the rarity and challenges of management in our environment.

Case presentation: The patient is a 62-year-old Cameroonian female farmer with recalcitrant back pain for two years until her symptom was significantly aggravated, causing her to have difficulty walking and standing. Besides, the patient presented with progressive fever, night sweats, and weight loss. Examination findings revealed gibbus at T7-11 vertebral spine. The bilateral upper and lower limbs’ findings confirmed power grade zero, hypotonia, and hypo-reflexes, the sensation was diminished (Quadriplegia). The CT myelogram showed multifocal worm-eaten and osteolytic bony destruction, appearance which suggests noncontiguous multilevel vertebral involvement in cervical, thoracic, lumbar, and sacral spine. Gene Xpert MTB/RIF test was positive. Sputum stain for acid-fast bacilli yielded Mycobacterial tuberculosis. The initial diagnosis was multiple myeloma or metastatic disease by the GP, but the final pathology confirmed skipped multifocal extensive TB involving the whole spine with quadriplegia, -an atypical form of spinal TB, which is extremely rare. Subsequently, the patient was commenced on a combination of anti-TB therapy and discharged in an improved state to continue the medication for 12 months.

Conclusion: While assessing patients with spinal TB or Pott’s disease, clinicians must recognize skipped multifocal extensive noncontiguous Pott’s disease as a potential differential diagnosis; that is rarely reported in the published literature. Interestingly, physicians have a global resolve that early diagnosis yields excellent results in Pott’s disease treatment. Finally, clinicians managing such cases should be well informed of the various limitations in such a resources-constrained environment like ours to reduce the risk of attendant morbidities and mortalities.


Keywords: Atypical lesion, Anti-TB treatment, Noncontiguous multisegment, Pott’s disease, Skip lesion, Spinal tuberculosis


 Received: August 30, 2020  Accepted: September 20, 2020  Published: October 30, 2020

Alegbeleye


Copyright © 2020 Direct Research Journal of Health and Pharmacology