[Tuberculosis of the spine and ribs].
Tuberculosis of the spine or ribs is uncommon, occurring in less than 1% of patients with tuberculosis (TB). 2 women are presented who recently immigrated from Ethiopia and India, respectively. One, aged 55, presented with chest pain, fatigue and several masses under the skin of the scalp. Chest X-ray and CT scan suggested Pancoast tumor, and the lateral parts of the first 2 right ribs were absent. The origin of the patient, clinical findings and positive PPD suggested TB of the ribs and anti-TB therapy resulted in cure. The diagnosis was later confirmed by a positive culture. The other woman, aged 68, presented with fatigue, mild abdominal pain and axillary lymphadenopathy. The PPD was positive and X-ray showed widening of the mediastinum. A caseating granuloma with Langhans epithelioid cells was found in a lymph node. Flaccid paraparesis developed before therapy was started. CT scan showed a typical picture of TB affecting the T3-T6 vertebrae. Drainage of a cold abscess of the spine via the anterior approach was followed by anti-TB therapy. Culture of a biopsied lymph node and of pus obtained at operation confirmed the diagnosis of TB. The patient died 2 months later from gastrointestinal bleeding. Awareness of the unusual presentations of various forms of TB is mandatory in countries with immigration from countries in which TB is still common.
Wishnitzer
R
R
Dept. of Medicine B, Kaplan Hospital, Rehovot.
Landow
Z
Z
Sagiv
S
S
Rozenhack
M
M
Eliraz
A
A
D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D007557:Israel; D008875:Middle Aged; D012272:Ribs; D013122:Spinal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy
D000995:Antitubercular Agents