Wellons John C, Zomorodi Ali R, Villaviciencio Alan T, Woods Christopher W, Lawson William T, Eastwood James D
Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Surg Neurol. 2004 Feb;61(2):136-9; discussion 139-41. doi: 10.1016/s0090-3019(03)00265-9.
We present a patient with a heterogeneously enhancing lesion within the body of the sacrum and the sacral canal. Sacral tuberculosis (TB) was suspected because of a history of familial exposure. Few cases isolated to the sacrum have been reported in the literature. The characteristic histopathologic and magnetic resonance imaging (MRI) findings are also presented.
A 31-year-old African-American male presented with an 8-month history of lower back pain radiating into his legs as well as numbness and weakness of the right foot. His history revealed PPD conversion following an exposure to active pulmonary TB 3 years prior for which he received 6 months of isoniazid prophylaxis. An MRI scan revealed a large heterogeneously enhancing lesion involving the sacrum with extension into the sacral canal. The patient underwent computed tomography (CT)- guided needle biopsy of the sacral lesion. Cytopathologic examination revealed caseating granulomas. Acid-fast bacilli cultures were positive for Mycobacterium tuberculosis. He was placed on a 6-month course of isoniazid, rifampin, pyrazinamide, and ethambutol. At 3-month follow-up, his examination and symptoms had improved.
Sacral TB is an extremely rare cause of lower back pain with radiation into the lower extremities. TB should always be considered in the differential diagnosis of isolated sacral masses, especially in light of today's increasing multidrug resistance and immunosuppressed population.
我们报告一例骶骨体和骶管内有不均匀强化病灶的患者。由于有家族接触史，怀疑为骶骨结核（TB）。文献中报道的孤立于骶骨的病例很少。本文还介绍了其特征性的组织病理学和磁共振成像（MRI）表现。
一名31岁的非裔美国男性，有8个月的下背部疼痛病史，疼痛放射至腿部，同时伴有右脚麻木和无力。他的病史显示，3年前因接触活动性肺结核后PPD试验转为阳性，为此他接受了6个月的异烟肼预防治疗。MRI扫描显示一个累及骶骨并延伸至骶管的大的不均匀强化病灶。患者接受了计算机断层扫描（CT）引导下的骶骨病变穿刺活检。细胞病理学检查显示干酪样肉芽肿。抗酸杆菌培养结果为结核分枝杆菌阳性。他接受了为期6个月的异烟肼、利福平、吡嗪酰胺和乙胺丁醇治疗。在3个月的随访中，他的检查结果和症状有所改善。
骶骨结核是下背部疼痛并放射至下肢的极其罕见的原因。在孤立性骶骨肿块的鉴别诊断中应始终考虑到结核，尤其是鉴于当今多药耐药性增加和免疫抑制人群增多的情况。
