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AB0855 Tuberculous Spondylodiscitis is not Unusual: about A Series of 35 Cases
  1. Z. Alaya,
  2. D. Amri,
  3. N. El Amri,
  4. K. Baccouche,
  5. S. Belghali,
  6. H. Zeglaoui,
  7. E. Bouajina
  1. Rheumatology department, Hospital Farhat Hached, Sousse, Tunisia

Abstract

Background Tuberculosis is enjoying a resurgence of interest, due to its current resurgence in the world. Osteoarticular location represents 3-5% of tuberculosis cases. Spondylodiscitis constitutes the most frequent location.

Objectives The objective of our study was to describe the biological, therapeutic, clinical and radiological aspects of tuberculous spondylodiscitis.

Methods This is a retrospective study of 35 cases of tuberculous spondylodiscitis collected in the Department of Rheumatology over a period of 15 years [1998-2013].

Results Our population consists of 14 men and 21 women with a sex ratio of 2/3. The mean age was 58.5 years [18-83]. Comorbidities noted were diabetes (n=4), renal failure (n=1) and systemic corticosteroid therapy (n=1). A history of tuberculosis was present in 4 patients. The circumstances of discovery were inflammatory spinal pain in 33 cases associated to general signs such alteration of the general state (n=22) and night sweats (n=11). Fever missing in 16 patients. Neurological impairment was objectified in 20 patients. Radicular pain was the most common manifestation. It was lumbosciatica (n=9), intercostal neuralgia (n=4), cruralgia (n=4) and cervico-brachial neuralgia (n=3). Motor deficit was objectified in 9 cases and vesicosphincteric disorders were noted in 4 patients. An array of spinal compression occurred in 6 cases. The mean disease duration was 8 months and a half. The biological inflammatory syndrome was absent in 2 cases. Plain radiographs were normal in 5 cases. CT performed in 22 cases and MRI performed in 25 cases showed an epiduritis in 18 cases, an infiltration of the soft parts in 12 cases, a soft parts abscess in 15 cases and root canal abscess in 7 cases. Spondylodiscitis was multistage in 4 cases and multifocal in 5 cases. Mycobacterium tuberculosis was isolated in 13 cases via a disco-vertebral puncture biopsy (n=5), via a puncture abscess (n=6), and a levy from another location (n=2). The tuberculous origin was retained in other cases based on clinical and radiological data. All patients were put on anti tuberculosis treatment. Surgery was required in 7 cases. The surgery was a decompressive laminectomy in 4 cases, a drain abscess in one case and the combination of two acts in two cases. The evolution was unfavorable in 2 cases with persistence of neurological sequelae. A case of vasculitis secondary to anti tuberculosis treatment was noted.

Conclusions Tuberculous spondylodiscitis has often an insidious development which is causing a delay in diagnosis. Isolation of Mycobacterium tuberculosis is difficult. The diagnosis is often based on a beam of arguments.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.4726

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