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An unusual case of craniovertebral junction tuberculosis in an infant
Sudhir K Kapoor1, Akshay Tiwari, Aashish Chaudhry
1Lady Hardinge Medical College and Associated Hospitals, New Delhi, India. akshay_t_2000@yahoo.com
Insights
This is the first reported case of infant craniovertebral junction tuberculosis causing complete quadriplegia. Prompt diagnosis and treatment led to a full recovery, highlighting the importance of high suspicion for this rare condition.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Spinal tuberculosis (TB) is increasingly recognized globally, with a rising incidence in developed nations.
- While spinal TB is common in children and young adults, it is rare in infants.
- Craniovertebral junction tuberculosis is an exceptionally rare form of spinal TB.
Observation:
- An infant presented at 9 months with Grade IV (complete) quadriplegia.
- Craniovertebral tuberculosis was suspected based on MRI findings and confirmed via fine needle aspiration cytology.
- The infant underwent transoral debridement, conservative immobilization, and 12 months of multidrug antitubercular therapy.
Findings:
- The infant experienced a complete recovery from quadriplegia within one year of treatment.
- Developmental milestones were achieved appropriately for age at the one-year follow-up.
Implications:
- Diagnosing and managing craniovertebral TB in infants presents unique challenges.
- A high index of suspicion is critical for early diagnosis and effective treatment in this vulnerable population.
- This case underscores the potential for successful outcomes with timely intervention in rare pediatric neurological conditions.
Study Design:
We present, to the best of our knowledge, the first reported case of craniovertebral junction tuberculosis with complete quadriplegia in an infant.
Objective:
To describe report of an unusual case and discuss the difficulties and peculiarities of diagnosis, management, and follow-up of craniovertebral tuberculosis in an infant.
Summary Of Background Data:
Spinal tuberculosis is prevalent in areas where tuberculosis is endemic, and its incidence is on the rise in developed nations with the rising incidence of HIV/AIDS. Although common in children and young adults, spinal tuberculosis is rare in infants. Again, craniovertebral tuberculosis is one of the rarest forms of spinal tuberculosis.
Methods:
The infant presented to us at the age of 9 months with Grade IV quadriplegia. Among many of the clinical differential diagnoses, craniovertebral tuberculosis was suspected only on MRI and proved after fine needle aspiration cytology demonstrated granulomas. The patient was subjected to transoral debridement, immobilized with help of a pair of pillows by either side of the head and multidrug antitubercular treatment was started, which continued for duration of 12 months.
Results:
At the last follow-up of 1 year, the patient had recovered fully and caught up with the milestones suitable for her age.
Conclusion:
Craniovertebral tuberculosis is difficult to diagnose and treat in infants. A high index of suspicion is essential for a prompt diagnosis and treatment, which is all the more crucial in this age group.
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