Vertebral tuberculosis revealed by thoracic manifestations. A study of five cases.
BACKGROUND
Spine is the most frequent location of bone tuberculosis, which can seldom be revealed by thoracic manifestations.


METHODS
In a seven-years retrospective study, we reported radioclinical manifestations revealing Pott's disease, methods of diagnosis and the treatment outcome.


RESULTS
Five non immunocompromised female patients were hospitalized between 1997 and 2003 in Clinical Department of Pulmonary Diseases in Abderrahmane Mami Hospital Ariana Tunisia, for thoracic manifestations that led to the diagnosis of Pott's disease, which represents 4.2% of extrapulmonary tuberculosis and 1.3% of all cases of tuberculosis cared for in the same period. The median age was 48.6 years. The disease was revealed by a paramediastinal radiographic shadow infiltrating the contiguous left lung in one case, abscesses of chest wall in two cases. Another patient was hospitalized for a tuberculous empyema. The last case had a diffuse miliary shadow in both lungs. All patients complained from thoracic or respiratory problems and constitutional symptoms, that evolved for an average of 5.6 months. Computed tomography (CT) and magnetic resonance imaging (MRI) of the spine identified monolevel spondylitis in two cases and multilevel disease in three cases. Diagnosis of tuberculous infection was confirmed in only one case by CT-guided biopsy of a perivertebral abscess, it was retained in three cases by bacteriological and or histopathological exams obtained from extra-vertebral lesions, and presumed in the fifth on a favorable treatment outcome. All patients had at least one extra-vertebral location of tuberculosis. Four patients were treated successfully with antituberculosis chemotherapy, prescribed for 18 to 22 months. Relapse occurred only in one patient, who received 12 months of treatment.


CONCLUSIONS
Pott's disease can be observed in non immunocompromised patients. In the Lung Diseases Department, it is often revealed by thoracic manifestations and associated to pulmonary lesions, which makes the formal diagnosis easy. Here, vertebral tuberculosis does not have anatomical specificities; nevertheless, the multilevel forms are relatively frequent. It constitutes an index of bacillus dissemination, requiring the search for other extra-vertebral locations.
Fennira
Hamouda
H
Service Femmes de Pneumologie Clinique, Hôpital Abderrahmane Mami Ariana, Tunisie.
Bourguiba
Maherzia
M
Ben Rejeb
Nadia
N
Ben Miled
Khaoula
K
Chermiti
Fatma
F
Maalej
Sonia
S
Drira
Ikram
I
Ben Kheder
Ali
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed; D014399:Tuberculosis, Spinal / Q000175:diagnosis*