Spores that crush the spine in infancy: a diagnostic challenge for an infant with spinal tuberculosis.

• Main Author: Mohamed, Mossad Abdelhak Shaban
• Format: Proceeding Paper
• Language: English; English
• Published: 2019
• Subjects: RJ Pediatrics; RJ101 Child Heatlh. Child health services. Preventive health services for children
• Online Access: http://irep.iium.edu.my/76483/3/76483%20abstract.pdf; http://irep.iium.edu.my/76483/4/76483%20slide.pdf; http://irep.iium.edu.my/76483/; https://helicsgroup.net/abstract_book/open/11#page/1
• Institution: Universiti Islam Antarabangsa Malaysia

Introduction Spinal tuberculosis in children is an established preventable disease. Complications of the disease are devastating due to its aptitude to cause bone destruction, spinal deformity and paraplegia. We present seven months old girl with isolated gross motor regression and evolving spastic paraplegia. The case highlights the challenge with the diagnosis we encountered until confirming the final diagnosis. Case summary The girl presented to the paediatric clinic with a history of legs weakness and loss of rolling after a period of prolonged febrile illness. She received a course of oral antibiotics. Both parents are medical practitioners. Mother had a history of SVT during pregnancy despite ablation and anti-arrhythmic treatments. Her father is a thalassaemia carrier. A thorough examination revealed gross motor developmental delay and upper motor neuron signs of both lower limbs. She had raised inflammatory markers, anaemia and thrombocytosis with persistent low-grade temperature. An urgent CT brain with contrast showed meningeal enhancement. Full septic workup revealed the CSF result reflecting partially treated meningitis. She was treated with third-generation cephalosporin and acyclovir. Mother claimed exposure to TB patients in her routine job hence Mantoux test was recommended which came positive for the baby but all other family members including midwife were negative. Her chest x-ray, sputum culture, CSF culture and NAA studies came non-conclusive for pulmonary tuberculosis. An urgent MRI for brain and spine showed features of tuberculous spondylo-discitis of T4-T6 vertebrae with associated subligamentous paravertebral spread and epidural extension causing spinal cord compression and T3-T6 hydro-syringomyelia. After multidisciplinary team discussion, the patient started on an intensive anti-tuberculosis regimen with the good initial response. Clinically lower limbs power turned near-normal and Laboratory and radiological investigations have normalize and spinal gibbous stay stationary with improvement in plain radiology. She is under regular follow up awaiting serial MRI. Conclusion The challenge in the diagnosis of extrapulmonary tuberculosis in infants is getting them excluded early. A high index of suspicion along with radiological investigation is vital to aid the diagnosis and establishment of treatment to expect a good outcome.