Canine Curt, Medeck Sarah, Hackett Anthony
Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Fort Hood, Texas.
Clin Pract Cases Emerg Med. 2019 Apr 2;3(2):107-111. doi: 10.5811/cpcem.2018.11.38575. eCollection 2019 May.
Spinal tuberculosis (STB), also known as tuberculous spondylitis, tuberculous vertebral osteomyelitis, or Pott's disease is a rare subset of extrapulmonary tuberculosis. Although rare in developed countries, STB is an important diagnosis for the emergency physician to consider. We report a case of a 44-year-old African-American male with STB presenting as an acute exacerbation of chronic low back pain complicated by urinary retention and difficulty ambulating. Our patient had no known predisposing risk factors for tuberculosis. This patient's STB was mistakenly diagnosed as nontuberculous vertebral osteomyelitis. This is not uncommon, as it is often difficult to distinguish the two clinically. This patient experienced advanced neurologic features at the time of initial presentation, which improved with surgical decompression. Ultimately, he re-presented to the emergency department 10 days after hospital discharge with recurrence of symptoms due to inaccurate antimicrobial selection. The diagnosis may hinge on the astute physician recognizing the characteristic, albeit subtle, imaging findings of STB.
脊柱结核（STB），也称为结核性脊柱炎、结核性椎体骨髓炎或波特氏病，是肺外结核中较为罕见的一种类型。尽管在发达国家较为罕见，但STB仍是急诊医生需要考虑的重要诊断。我们报告一例44岁非裔美国男性脊柱结核病例，表现为慢性腰痛急性加重，并伴有尿潴留和行走困难。我们的患者没有已知的结核病易感风险因素。该患者的脊柱结核被误诊为非结核性椎体骨髓炎。这种情况并不少见，因为临床上往往难以区分这两者。该患者在初次就诊时出现了严重的神经功能症状，经手术减压后有所改善。最终，他在出院10天后因抗菌药物选择不当导致症状复发，再次前往急诊科就诊。诊断可能取决于敏锐的医生能否识别出脊柱结核的特征性影像学表现，尽管这些表现较为细微。
