Progressive Thoracolumbar Tuberculosis in a Young Male: Diagnostic, Therapeutic, and Surgical Insights.

IF 3.4 Q2 INFECTIOUS DISEASES Infectious Disease Reports Pub Date : 2024-10-12 DOI:10.3390/idr16050080
Dana-Georgiana Nedelea, Diana Elena Vulpe, George Viscopoleanu, Alexandru Constantin Radulescu, Alexandra Ana Mihailescu, Sebastian Gradinaru, Mihnea Orghidan, Cristian Scheau, Romica Cergan, Serban Dragosloveanu
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Abstract

Objective: We present the case of a 26-year-old male with severe spinal tuberculosis of the thoracolumbar region. The patient suffered from worsening back pain over five years, initially responding to over-the-counter analgesics. Despite being proposed surgery in 2019, the patient refused the intervention and subsequently experienced significant disease progression.

Methods: Upon re-presentation in 2022, mild involvement of the T12-L1 vertebrae was recorded by imaging, leading to a percutaneous needle biopsy which confirmed tuberculosis. Despite undergoing anti-tuberculous therapy for one year, the follow-up in 2024 revealed extensive infection from T10 to S1, with large psoas abscesses and a pseudo-tumoral mass of the right thigh. The patient was ultimately submitted to a two-stage surgical intervention: anterior resection and reconstruction of T11-L1 with an expandable cage, followed by posterior stabilization from T8-S1.

Results: Postoperative recovery was uneventful, with significant pain relief and no neurological deficits. The patient was discharged on a continued anti-tuberculous regimen and remains under close surveillance.

Conclusions: This paper presents details on the challenges of diagnosis and management of severe spinal tuberculosis, with emphasis on the importance of timely intervention and multidisciplinary care.

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一名年轻男性的进行性胸腰椎结核病:诊断、治疗和手术的启示。
目的:我们介绍了一例 26 岁男性胸腰部严重脊柱结核患者的病例。患者五年来背痛不断加重,最初对非处方止痛药有反应。尽管医生在2019年建议患者进行手术治疗,但患者拒绝了,随后病情出现了显著进展:2022年再次就诊时,影像学检查发现T12-L1椎体轻度受累,随后进行了经皮穿刺活检,确诊为肺结核。尽管接受了一年的抗结核治疗,但2024年的随访显示,T10至S1椎体广泛感染,并伴有腰大肌脓肿和右大腿假性肿瘤肿块。患者最终接受了两阶段手术治疗:前部切除并用可扩张骨笼重建T11-L1,然后从T8-S1进行后部稳定:术后恢复顺利,疼痛明显缓解,无神经功能障碍。患者出院后继续接受抗结核治疗,目前仍在密切观察中:本文详细介绍了严重脊柱结核的诊断和管理所面临的挑战,强调了及时干预和多学科护理的重要性。
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来源期刊
Infectious Disease Reports
Infectious Disease Reports INFECTIOUS DISEASES-
CiteScore
5.10
自引率
0.00%
发文量
82
审稿时长
11 weeks
期刊最新文献
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