Unusual Presentation of Isolated Sacral Tuberculosis

doi:10.1016/j.jbspin.2006.01.016

Joint Bone Spine

Volume 73, Issue 6, December 2006, Pages 751-752

https://doi.org/10.1016/j.jbspin.2006.01.016 Get rights and content

Abstract

Tuberculosis is as old as mankind. Vertebral tuberculosis is fairly common form of bone and joint tuberculosis. However, isolated sacral tuberculosis is rare. It may present as an atypical sacral lesion having epidural granuloma without destruction of sacrum on MRI and plain X-rays. This atypical presentation may lead to delay in diagnosis and treatment. This case report intends to emphasize that spinal tuberculosis should be the first and foremost differential diagnosis in the presence of atypical clinical and radiological features of a sacral lesion particularly in developing countries. Early diagnosis and treatment can prevent or minimize the neurological morbidity in such cases.

Introduction

Vertebral tuberculosis is the commonest form of skeletal tuberculosis constituting about 50% of all cases of tuberculosis of bones and joints [1]. Literature regarding isolated sacral tuberculosis is scanty and it is usually reported as a part of lumbo-sacral tuberculosis (3–7%) [1]. It commonly presents with chronic low backache, discharging sinuses or abscess with or without neurological deficit [2]. Isolated sacral tuberculosis may also have atypical presentation of epidural soft tissue mass [2] or prolapsed intervertebral disc. The patient in our case had both these rare presentations making the diagnosis a difficult one.

Section snippets

Case report

A 35-year-old female patient presented with 1 year history of recurrent episodes of mild to moderate pain and stiffness of the lower back. She had no history of low-grade fever, decreased appetite, weight loss, involvement of bowel and bladder. She also had no history of trauma to the back. Pain used to radiate to both lower leg and ankles, it was aggravated by walking and relieved by rest. Physical examination revealed paravertebral muscle spasm and tenderness over the lower lumbar and sacral

Discussion

India has one fifth of world's tuberculosis suffering population, out of which skeletal tuberculosis constitutes 3% [3]. Fifty percent of these have tuberculosis of spine [3]. Isolated sacral tuberculosis is rare [2], [4]. It usually presents as chronic back pain in adults and discharging sinuses or abscess in children [2]. Neurological deficit is relatively uncommon in isolated sacral tuberculosis [2]. Radiologically pre and parasacral collection with destruction of the sacrum is seen on CT

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There are more references available in the full text version of this article.

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Isolated sacral tuberculosis: A case report and systematic literature review
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Tuberculosis remains a rampant infectious disease affecting developing countries. Isolated sacral tuberculosis is extremely rare. The aim of this work was to highlight the epidemiological, clinical, radiological features and outcomes of this rare site of spinal tuberculosis.
We report a case of a 62-year-old-man patient that presented an isolated sacral tuberculosis. We conducted research on PubMed and Scopus databases from 1974 to March 2023 using the following search terms \“isolated AND sacral AND tuberculosis\”.
We retrieved 7 case reports and 1 case series published. A total of 10 patients were identified. The mean age was 37.6 ± 15.4 years (range 20–72). There were 3 males and 7 females. The most common symptoms were sciatica (70%). Neurological examination revealed monoparesis (10%), paraparesis (20%) and no motor deficit (70%). The radiological characteristics of mass lesion, on magnetic resonance imaging, were low intensity in T1-weighted imaging and high intensity in T2-weighted imaging (80%), with paravertebral abscess (90%). The procedures of diagnosis mostly used were needle aspiration (80%). All patients saw clinical improvement (100%).
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Even in large series, no patient had an isolated sacral form of tuberculosis [4–6]. Studies on cases with isolated form of tuberculosis affecting the sacrum are rare [3,8–11]. The usual presentation is a chronic low back pain, a fistula or abscess with or without neurologic deficit [11].
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Isolated sacral tuberculosis is rare but a high degree of suspicion is needed in the presence of atypical clinical and radiological features of a sacral lesion particularly in Black Africa.
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In chordomas, such genetic abnormalities as structural chromosomal abnormalities,18 microsatellite instability,19 and polyclonality20 were also described, but these results were not validated and have not had any therapeutic consequences. Histologic examination can clarify the diagnosis in cases of rare sacral tumorlike conditions, such as osteomyelitis21 and tuberculosis22 as well as determine the origin of sacral metastases.23 Treatment of sacral metastatic lesions can be different from the therapeutic approach of primary tumors.
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Case reportUnusual Presentation of Isolated Sacral Tuberculosis

Abstract

Introduction

Section snippets

Case report

Discussion

Joint Bone Spine

Neurological complications

Imaging in isolated sacral tuberculosis: a review of 15 cases

Skeletal Radiology

Tuberculosis of spine

Case report
Unusual Presentation of Isolated Sacral Tuberculosis