Secondary anaerobic infection in a case of multidrug resistant tubercular paraspinal abscess: A rare presentation

Paraspinal abscesses are most commonly caused by Staphylococcus aureus and some Gram-negative bacteria. In developing countries, Mycobacterium tuberculosis (MTB) contributes to almost 50 % of cases. Even in proven cases of tubercular paraspinal abscesses, secondary infection of aerobic or anaerobic bacteria is possible and should be carefully evaluated for proper management.

A type I diabetes mellitus patient presented with chronic backache and lower limb weakness and radiological investigations showed paraspinal collections suggestive of tuberculosis. The patient was then started on anti-tubercular drugs, she initially responded and then showed gradual deterioration in the form of increased pain, fever and pus discharge. Aerobic cultures of pus were sterile and anaerobic culture grew Peptoniphilus asaccharolyticus sensitive to metronidazole. Appropriate treatment had resulted in clinical improvement.

Suspicion about co-infection with aerobic or anaerobic bacteria should be high even in proven cases of tubercular paraspinal abscess not improving despite proper anti-tubercular therapy.