Novita Bernadette Dian, Muliono Ari Christy, Wijaya Sumi, Theodora Imelda, Tjahjono Yudy, Supit Vincentius Diamantino, Willianto Vincentius Michael
Department of Pharmacology and Therapy, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya 60113, East Java, Indonesia.
Department of Internal Medicine, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya 60113, Indonesia.
World J Clin Cases. 2022 Jul 26;10(21):7451-7458. doi: 10.12998/wjcc.v10.i21.7451.
Tuberculosis (TB) remains one of the highest Asia's health problems. Spondylitis TB in diabetes mellitus (DM) and hypothyroidism patients is a rare case of extrapulmonary tuberculosis. However, there is a lack of therapeutic guidelines to treat spondylitis TB, particularly with type 2 DM (T2DM) and hypothyroidism as comorbidities. Here we present a case of spondylitis TB with T2DM and hypothyroidism in a relatively young patient and its therapeutic procedure.
We report the case of a 35-year-old male patient from Surabaya, Indonesia. Based on anamnesis, physical examination, and magnetic resonance imaging, the patient has been categorized in stage II of spondylitis TB with grade 1 paraplegia. Surprisingly, the patient also had a high HbA1c level, high thyroid stimulating hormone, and low free T (FT), which indicated T2DM and hypothyroidism. A granulomatous process was observed in the histopathological section. The antituberculosis drugs isoniazid and rifampicin were given. In addition, insulin, empagliflozin, and linagliptin were given to control hyperglycemia conditions, and also levothyroxine to control hypothyroidism.
The outcome was satisfactory. The patient was able to do daily activities without pain and maintained normal glycemic and thyroid levels. For such cases, we recommend the treatment of spondylitis TB by spinal surgery, together with T2DM and hypothyroidism therapies, to improve the patients' condition. Prompt early and non-invasive diagnoses and therapy are necessary.
结核病仍然是亚洲最严重的健康问题之一。糖尿病（DM）和甲状腺功能减退患者的脊柱结核是一种罕见的肺外结核病例。然而，目前缺乏治疗脊柱结核的指南，尤其是对于合并2型糖尿病（T2DM）和甲状腺功能减退的情况。在此，我们介绍一例相对年轻患者的脊柱结核合并T2DM和甲状腺功能减退病例及其治疗过程。
我们报告一例来自印度尼西亚泗水的35岁男性患者。根据病史、体格检查和磁共振成像，该患者被归类为脊柱结核II期，伴有1级截瘫。令人惊讶的是，该患者还具有高糖化血红蛋白水平、高促甲状腺激素水平和低游离T（FT）水平，提示患有T2DM和甲状腺功能减退。在组织病理学切片中观察到肉芽肿形成过程。给予抗结核药物异烟肼和利福平。此外，给予胰岛素、恩格列净和利格列汀以控制高血糖状况，并给予左甲状腺素以控制甲状腺功能减退。
结果令人满意。患者能够无痛地进行日常活动，血糖和甲状腺水平保持正常。对于此类病例，我们建议通过脊柱手术治疗脊柱结核，并结合T2DM和甲状腺功能减退治疗，以改善患者状况。及时进行早期和非侵入性诊断及治疗是必要的。
