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Area of Science:

  • Medical Science
  • Infectious Diseases
  • Orthopedics

Background:

  • Tuberculosis (TB) remains a significant public health concern in Portugal.
  • Extrapulmonary TB, particularly spinal involvement (vertebral TB), presents diagnostic challenges.
  • Spinal TB can lead to severe neurological deficits if not promptly addressed.

Observation:

  • A 65-year-old male presented with lumbar sciatic pain, significant weight loss, and anorexia.
  • Neurological symptoms including hemiparesis and hypoesthesia developed, unresponsive to analgesia.
  • Imaging revealed L5-S1 spondylodiscitis, prompting further investigation.

Findings:

  • Surgical decompression of a lumbar abscess led to the isolation of multi-sensitive Mycobacterium tuberculosis.
  • The patient received a year of anti-tuberculostatic drugs and physiotherapy.
  • Complete recovery from neurological deficits was achieved post-treatment.

Implications:

  • This case highlights the importance of high clinical suspicion for spinal tuberculosis due to its prolonged and non-specific presentation.
  • Timely diagnosis and appropriate treatment are essential to prevent irreversible neurological damage.
  • Effective management involves a combination of antimicrobial therapy, surgical intervention when necessary, and rehabilitation.