[Recurrent shoulder pain indicative of a tuberculous cervical spondylodiscitis]

Shoulder pain is usually related to local osteoarticular or periarticular diseases of mechanical or inflammatory origin. Occasionally, it can be secondary to a discoradicular compression in the cervical spine. We report the case of a 67-year-old woman who was hospitalized for degradation of her general state, inflammation and painful shoulders. General and ear-nose-throat examinations were normal. Pain was elicited by palpation of the shoulders and the cervical spine. The mobility of shoulders and the neck was complete and painless. Laboratory tests showed inflammation with marked eosinophilia. Plain radiographs of the shoulders were normal. A 99mTc total bone scintigraphy showed an increased uptake ranging from D3 to D12. The thoraco-abdominal CT scan was normal. The evolution after seven months was marked by a occurrence of a sudden tetraparesy. The neck CT scan and magnetic resonance imagery showed a C6-C7 spondylodiscitis. The patient was operated and the symptoms disappeared. The Löwensten's culture of the removed discal tissue was positive and confirmed the presence of a Pott's disease. The evolution was favorable with a specific quadri-therapy for nine months. A negative scintigraphy and the presence of an eosinophilia were misleading in the present case. For shoulder pain without a clear etiology, cervical exploration should be adviced. Cervical tuberculosis can begin with isolated shoulder pain.