1114 - Spinal Cord Injury After Fall in Setting of Spinal Tuberculosis: A Case Report

Spinal tuberculosis (STB) is a devastating condition due to its nonspecific early symptoms and subacute course leading to delayed diagnosis. Backache and paraparesis are common symptoms of STB due to orthopedic damage and distortion of spinal anatomy, which may lead to spinal cord injury (SCI).

Case Description:

A 24-year-old male presented after a fall with neck pain, upper extremity paresthesias, and difficulty ambulating. He reported a painless fluctuant mass with skin erosion over the lateral chest wall 10 months prior with some recent drainage. Imaging revealed cervical lytic lesions with pathologic C3 vertebral body fracture and severe spinal canal narrowing from C2 through C4, requiring C3 and C4 corpectomy and C2-C5 fusion. His initial exam was consistent with central cord syndrome and he was treated for presumed Cutibacterium osteomyelitis prior to admission to inpatient rehabilitation. His rehabilitation was interrupted due to late return of intraoperative spinal cultures concerning for mycobacterium tuberculosis – despite no classic risk factors – requiring transfer back to acute care for pulmonary TB rule-out and initiation of antitubercular treatment.

Discussions:

STB remains a public health issue, and late diagnosis is an important factor in prognostication. The delayed diagnosis of STB led to persistent neurologic deficits and suspension of his rehabilitation course for his SCI due to need for airborne precautions and treatment requiring acute care admission. The presence of an abscess without inflammatory signs, or a “cold abscess,” has been associated with STB. Given our patient’s skin lesion and symptoms, it is possible that earlier detection of STB could have prevented pathologic fracture and subsequent SCI.

Conclusions:

Our patient demonstrates that, even in the absence of classic TB risk factors, the presence of a cold abscess in a patient with axial pain should raise suspicion for STB given the potential for irreversible neurologic injury and delayed diagnosis impeding further rehabilitation.