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[Tuberculosis of the spine in children. Personal experience]
E Mantero1, F Casu, G Asquasciati
1Università degli Studi di Genova, II Clinica Malattie Infettive Instituto Giannina Gaslini, Genova.
Insights
This case study details a rare spinal tuberculosis (Pott's disease) in a young child. Effective treatment involved chemotherapy and conservative orthopedic management, leading to full recovery.
Area of Science:
- Pediatric Infectious Diseases
- Spinal Tuberculosis (Pott's Disease)
- Musculoskeletal Infections
Background:
- Tuberculosis is re-emerging globally, with spinal involvement being exceptionally rare, particularly in European studies.
- Pott's disease, a severe form of tuberculosis affecting the spine, requires prompt diagnosis and management.
Observation:
- A 3-year-old child presented with inguinal swelling, fever, and anemia, indicative of an underlying infection.
- Diagnostic imaging revealed an L5-S1 intervertebral abscess, osteolytic lesions, and psoas muscle involvement, consistent with Pott's disease.
Findings:
- A 24-month chemotherapy regimen (isoniazid, ethambutol, rifampicin, streptomycin) combined with ileopsoas abscess drainage was initiated.
- One year of conservative orthopedic treatment, including bed rest with spinal hyperdistension, a plaster cast, and a resin jacket, was administered.
Implications:
- This case highlights successful management of pediatric spinal tuberculosis through a multimodal approach.
- Complete recovery was achieved with vertebral reconstruction and intervertebral space preservation, underscoring the efficacy of prolonged treatment.
Abstract:
We are currently witnessing a worldwide return of tuberculosis. An extremely rare form is tuberculosis of the spine which is reported above all in extra-European studies. The authors report a case of Pott's disease in a child aged 3 years and 3 months who was referred to their attention due to the appearance of left inguinal swelling, fever and anemia. Diagnostic tests (ETG, CT, MR) showed an abscess involving the L5-S1 intersomatic space, the intervertebral disc and osteolytic lesions of S1, with impairment of the left psoas muscle and diffusion as far as the inguinal region. Chemotherapy was commenced using isoniazid, ethambutol, rifampicin, and streptomycin and lasted 24 months associated with drainage of the ileopsoas abscess. Conservative orthopedic treatment lasting for one year initially took the form of decubitus in bed with hyperdistension of the vertebral column, followed by the creation of a plaster-cast cot on the back and lastly a glass-reinforced resin orthopedic jacket. The follow-up of 2 years and 10 months showed recovery with reconstruction of the vertebral elements and the preservation of intervertebral space.