Calderón-Garcidueñas Ana Laura, Jiménez-López Marco Antonio, Díaz-Vintimilla Juan José
Secretaría de Salud, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Departamento de Neuropatología. Ciudad de México, México.
Secretaría de Salud del Estado de Durango, Hospital General 450, Departamento de Anatomía Patológica. Durango, Durango, México.
Rev Med Inst Mex Seguro Soc. 2024 Jul 1;62(4):1-7. doi: 10.5281/zenodo.11397264.
Osteoarticular tuberculosis represents 9-20% of extrapulmonary forms and spinal tuberculosis is its most common form.
We present three cases of tuberculous spondylitis in patients aged 22, 36 and 68 years, with 8, 6 and 6 months of evolution and with involvement of L5-S1, T7-T8 and T5-T6, respectively. The two younger patients had disc involvement, and in the first case a pyogenic abscess was initially suspected. Local pain was the initial symptom and the 2 older patients developed inability to walk and urinary and fecal incontinence. The patients received a complete anti-tuberculosis regimen and the postoperative evolution was satisfactory. All showed expression of tumor necrosis factor in the epithelioid and giant cells of the granulomas and activation of nuclear factor κβ in the accompanying lymphocytes.
The persistence of localized spinal pain, with or without local volume increase, should alert the physician to the possibility of a spinal infectious process, including tuberculosis.
骨关节结核占肺外结核的9 - 20%,脊柱结核是其最常见的形式。
我们报告了3例结核性脊柱炎患者,年龄分别为22岁、36岁和68岁,病程分别为8个月、6个月和6个月,受累节段分别为L5 - S1、T7 - T8和T5 - T6。两名较年轻的患者椎间盘受累,在第一例中最初怀疑为化脓性脓肿。局部疼痛是初始症状,两名老年患者出现行走困难及大小便失禁。患者接受了完整的抗结核治疗方案,术后病情进展令人满意。所有患者的肉芽肿上皮样细胞和巨细胞中均有肿瘤坏死因子表达,伴随的淋巴细胞中有核因子κβ激活。
局限性脊柱疼痛持续存在,无论有无局部肿胀,都应提醒医生注意包括结核在内的脊柱感染性疾病的可能性。