Tuberculous spondylitis in a patient with Crohn’s disease using immunosuppressant therapy: case report
DOI:
https://doi.org/10.34019/1982-8047.2021.v47.34257Keywords:
Tuberculosis, Crohn’s Disease, Spinal Tuberculosis, Spinal FusionAbstract
Introduction: Infection with Mycobacterium tuberculosis (Mt) is one of the ten main causes of mortality in the world. Only 0.5% of tuberculosis (TB) cases are in the spine, leading to neurological disorders, mechanical instability and deformities. The use of immunosuppressive drugs to treat inflammatory diseases such as Crohn's disease (CD) can make the patient susceptible to this opportunistic infection. Objective: Report the case of a patient with tuberculous spondylitis undergoing treatment for CD with immunosuppressive therapy. We describe its clinical-surgical treatment and evolution comparing it with the current literature. Case Report: A 51-year-old woman, diagnosed with CD in continuous use of azathioprine, was admitted to our hospital for worsening middle back pain, difficulty in walking and weight loss without neurological repercussions. Magnetic Resonance (MRI) and Computerized Tomography (CT) of the dorsal column showed patterns suggestive of tuberculous spondylitis. Because of the disease´s evolution without pain relief and associated with vertebral instability with imminent risk of fracture and neurological damage, surgery was indicated for vertebral stabilization, decompression of neural elements and removal of material for histopathological study. The result confirmed the presence of Mt in the sample. The patient was hospitalized for 28 days with antibiotic treatment, showing good evolution, with progressive improvement in pain and walking. During his entire hospital stay, his CD condition was kept under control. Conclusion: It is important to consider tuberculous spondylitis as a differential diagnosis in patients with back pain and alarm signs, especially in the presence of immunosuppressive treatment, even with negative PPD.
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Copyright (c) 2021 Guilherme Gouveia Hollunder, Marcus Vinicius De Oliveira Ferreira, Caio Gomes Tabet, Valdeci Manoel de Oliveira, Jair Moreira Dias Junior
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