Sacral tuberculosis: an atypical manifestation

Sacral tuberculosis (TB) is extremely rare and its unusual entity might delay the diagnosis and treatment of this treatable disease. A 38-year-old lady presented with a 1 year history of lower back pain with radiculopathy more to right lower limb. The patient was initially treated as Prolapsed Inter...

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Main Authors:	Si Mirah, Faisal Amir, Roslan, Ahmad Faizal, Mor Japar Khan, Ed Simor Khan, Karupiah, Rajandra Kumar, Zakaria@Mohamad, Zamzuri
Format:	Article
Language:	English
Published:	Kulliyyah of Medicine, International Islamic University Malaysia 2018
Subjects:	RD701 Orthopedics
Online Access:	http://irep.iium.edu.my/67510/ http://irep.iium.edu.my/67510/ http://irep.iium.edu.my/67510/1/Sacral%20Tuberculosis%20-%20An%20Atypical%20Manifestation%20%282%29.pdf

id	iium-67510
recordtype	eprints
spelling	iium-675102019-01-15T08:14:39Z http://irep.iium.edu.my/67510/ Sacral tuberculosis: an atypical manifestation Si Mirah, Faisal Amir Roslan, Ahmad Faizal Mor Japar Khan, Ed Simor Khan Karupiah, Rajandra Kumar Zakaria@Mohamad, Zamzuri RD701 Orthopedics Sacral tuberculosis (TB) is extremely rare and its unusual entity might delay the diagnosis and treatment of this treatable disease. A 38-year-old lady presented with a 1 year history of lower back pain with radiculopathy more to right lower limb. The patient was initially treated as Prolapsed Intervertebral Disc (PID), but showed no improvement despite regular physiotherapy and medication. Subsequently, the pain was confined to the right gluteal area and became more severe. Quality of life was impaired in which patient started using walking aids and stopped working. There was a weight loss of 20kg. No other symptom of TB infection or history of contact with TB patient. Bowel and urinary functions were normal. Examination showed localized tenderness at the right gluteal area. Neurological assessment of both lower limbs were MRC grade 5. Blood investigations were normal including the ESR level (17mm/hour). Mantoux test was positive with 18mm induration. MRI revealed a large rim enhancing paravertebral collection at pre-sacral space which extended into bilateral piriformis and gluteal muscles. The patient underwent CT-guided drainage of both gluteals and specimens taken to confirm the diagnosis of TB. Patient showed significant improvement clinically within 1 week after the drainage procedure and initiation of antituberculous chemotherapy. The initial presentation of this patient mimics PID due to irritation of sciatic nerve at piriformis level. However a change in the presentation and failure of conservative treatment should raise a high index of suspicion and necessitates further investigation to establish correct diagnosis hence proper treatment can be initiated. Kulliyyah of Medicine, International Islamic University Malaysia 2018-12-14 Article PeerReviewed application/pdf en http://irep.iium.edu.my/67510/1/Sacral%20Tuberculosis%20-%20An%20Atypical%20Manifestation%20%282%29.pdf Si Mirah, Faisal Amir and Roslan, Ahmad Faizal and Mor Japar Khan, Ed Simor Khan and Karupiah, Rajandra Kumar and Zakaria@Mohamad, Zamzuri (2018) Sacral tuberculosis: an atypical manifestation. International Medical Journal Malaysia, 17 (Supplementary Issue 1). p. 90. E-ISSN 1823-4631 http://iiumedic.net/imjm/v1/download/vol_17_no_3_supp_1/MRS2018-91.pdf
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	RD701 Orthopedics
spellingShingle	RD701 Orthopedics Si Mirah, Faisal Amir Roslan, Ahmad Faizal Mor Japar Khan, Ed Simor Khan Karupiah, Rajandra Kumar Zakaria@Mohamad, Zamzuri Sacral tuberculosis: an atypical manifestation
description	Sacral tuberculosis (TB) is extremely rare and its unusual entity might delay the diagnosis and treatment of this treatable disease. A 38-year-old lady presented with a 1 year history of lower back pain with radiculopathy more to right lower limb. The patient was initially treated as Prolapsed Intervertebral Disc (PID), but showed no improvement despite regular physiotherapy and medication. Subsequently, the pain was confined to the right gluteal area and became more severe. Quality of life was impaired in which patient started using walking aids and stopped working. There was a weight loss of 20kg. No other symptom of TB infection or history of contact with TB patient. Bowel and urinary functions were normal. Examination showed localized tenderness at the right gluteal area. Neurological assessment of both lower limbs were MRC grade 5. Blood investigations were normal including the ESR level (17mm/hour). Mantoux test was positive with 18mm induration. MRI revealed a large rim enhancing paravertebral collection at pre-sacral space which extended into bilateral piriformis and gluteal muscles. The patient underwent CT-guided drainage of both gluteals and specimens taken to confirm the diagnosis of TB. Patient showed significant improvement clinically within 1 week after the drainage procedure and initiation of antituberculous chemotherapy. The initial presentation of this patient mimics PID due to irritation of sciatic nerve at piriformis level. However a change in the presentation and failure of conservative treatment should raise a high index of suspicion and necessitates further investigation to establish correct diagnosis hence proper treatment can be initiated.
format	Article
author	Si Mirah, Faisal Amir Roslan, Ahmad Faizal Mor Japar Khan, Ed Simor Khan Karupiah, Rajandra Kumar Zakaria@Mohamad, Zamzuri
author_facet	Si Mirah, Faisal Amir Roslan, Ahmad Faizal Mor Japar Khan, Ed Simor Khan Karupiah, Rajandra Kumar Zakaria@Mohamad, Zamzuri
author_sort	Si Mirah, Faisal Amir
title	Sacral tuberculosis: an atypical manifestation
title_short	Sacral tuberculosis: an atypical manifestation
title_full	Sacral tuberculosis: an atypical manifestation
title_fullStr	Sacral tuberculosis: an atypical manifestation
title_full_unstemmed	Sacral tuberculosis: an atypical manifestation
title_sort	sacral tuberculosis: an atypical manifestation
publisher	Kulliyyah of Medicine, International Islamic University Malaysia
publishDate	2018
url	http://irep.iium.edu.my/67510/ http://irep.iium.edu.my/67510/ http://irep.iium.edu.my/67510/1/Sacral%20Tuberculosis%20-%20An%20Atypical%20Manifestation%20%282%29.pdf
first_indexed	2023-09-18T21:35:50Z
last_indexed	2023-09-18T21:35:50Z
_version_	1777412813881344000

Sacral tuberculosis: an atypical manifestation

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