Tuberculosis of the Cervical Spine Mimicking a Paraplegic Tumour in Immuno-Compomised Patient: Case Report

Abstract

Tuberculosis (TB) of the spine is a common problem in Kenya especially since the spread of HIV infection in the 1980’s. However immune-compromised patients do not necessarily present in a similar radiological and histopathological way as patients with a competent immune system. It is against this background that we present the case of a 50-year old male living with HIV/AIDS who presented with progressive lower limb weakness and paraesthesia for the past two months. Magnetic Resonence Imaging (MRI)and x-rays revealed an infiltrative lesion of C6-C7 vertebrae. Our main diffential diagnosis was a primary or metastatic. Though TB was one of our differential diagnoses, we considered it less likely considering the infiltrative nature of the lesion, and the absence of paravertebral abscess. The patient underwent anterior cervical corpectomy of C6-C7, iliac crest grafting and instrumented fusion from C5-T1. Intra-operatively, the lesion was found to have been a fleshy, non-caseating and suggestive of tumour. However, histopathology results revealed TB with multinucleate giant cells and poor granuloma formation. This case illustrates that TB of the spine in patients who are immuno-compromised may present atypically as fleshy grey necrotic material similar to a tumour when the immune system is not competent enough to mount an adequate response to result in caseation and abscess formation.