el-Shahawy M A, Gadallah M F, Campese V M
Division of Nephrology, University of Southern California, Los Angeles.
Am J Nephrol. 1994;14(1):55-9. doi: 10.1159/000168686.
Extrapulmonary tuberculosis is more common in end-stage renal disease than in normal subjects, and it frequently poses both diagnostic and therapeutic challenges. We describe 2 dialysis patients with tuberculosis of the spine (Pott's disease). The 1st patient presented with back and left hip pain, low-grade fever, left-quadriceps weakness, hypoesthesia of the left thigh, and hypoactive left-knee jerk. X-rays of the spine showed only osteophytes. Magnetic resonance imaging showed increased signal intensity of L3 with focal expansion into the spinal canal. A computerized tomography guided biopsy revealed granulomas, and Ziehl-Neelsen stain was positive. Therapy with rifampin, isoniazid, ethambutol, and pyrazinamide caused peripheral neuropathy and optic neuritis. The 2nd patient developed bilateral proximal thigh pain and weakness that progressed to paraplegia. Magnetic resonance imaging showed destructive lesion of L3-5, involving both psoas muscles, prevertebral space, and neural foramina. Ziehl-Neelsen stain of the biopsy specimen was negative, but culture was positive for Mycobacterium tuberculosis. Paraplegia improved only partially after 1 year of therapy. Pott's disease should be suspected in end-stage renal disease patients with back pain and/or neuromuscular complaints, particularly in those who immigrated from Asian and Latin-American countries. Treatment of tuberculosis in dialysis patients may cause significant morbidity.
肺外结核在终末期肾病患者中比在正常人群中更常见，并且它常常给诊断和治疗带来挑战。我们描述了2例患有脊柱结核（波特氏病）的透析患者。首例患者表现为背部和左髋部疼痛、低热、左股四头肌无力、左大腿感觉减退以及左膝反射减弱。脊柱X线片仅显示有骨赘。磁共振成像显示L3信号强度增加，有局灶性扩展至椎管内。计算机断层扫描引导下活检发现肉芽肿，萋-尼染色呈阳性。使用利福平、异烟肼、乙胺丁醇和吡嗪酰胺治疗导致了周围神经病变和视神经炎。第二例患者出现双侧大腿近端疼痛和无力，并进展为截瘫。磁共振成像显示L3至L5有破坏性病变，累及双侧腰大肌、椎前间隙和神经孔。活检标本的萋-尼染色为阴性，但结核分枝杆菌培养呈阳性。经过1年治疗后截瘫仅部分改善。对于有背痛和/或神经肌肉症状的终末期肾病患者，尤其是那些来自亚洲和拉丁美洲国家的移民，应怀疑患有波特氏病。透析患者的结核病治疗可能会导致显著的发病率。
