Craniovertebral junction tuberculosis: a case report and review of the literature

Craniovertebral junction tuberculosis (CVJ TB) is a rare disease, potentially causing significant neurological deficits and even death. We report on a 80-year-old woman presenting with CVJ TB without pulmonary involvement. The diagnosis was made by biopsy of the cervical lymph node showing granulomatous caseation necrosis. Despite extensive erosion of the clivus, C1, and C2, and spinal cord compression, the patient was effectively managed with antituberculous drug therapy and conservative neck stabilization. Neck pain resulting from cervical spondylosis is common in elderly people. However, even if there is no obvious pulmonary involvement, CVJ TB should be considered in the differential diagnosis, especially in patients with painful neck stiffness. The most useful method available for evaluating this region is a combination of CT scan and MRI study. CVJ TB can be managed conservatively, except for a selected few cases, regardless of the extent of bony destruction.