The spine crasher: a challenging diagnosis

Spinal tuberculosis in children is an established preventable disease in developing countries. Complications are devastating due to its aptitude to cause bone destruction, spinal deformity and paraplegia. We present an eight-month old girl with isolated gross motor regression and evolving spastic pa...

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Main Authors:	Anuar, Muhamad Azamin, Shaban Mohamed, Mossad Abdelhak, Mohd Azhar, Nur Syuhada, Abu Bakar, Asrar, Hasan, Taufiq Hidayat
Format:	Conference or Workshop Item
Language:	English English
Published:	2019
Subjects:	RD701 Orthopedics RJ Pediatrics RJ101 Child Health. Child health services
Online Access:	http://irep.iium.edu.my/75487/ http://irep.iium.edu.my/75487/1/POSTER%20TB%20SPINE%20SYUHA%20PDF.pdf http://irep.iium.edu.my/75487/19/75487%20abstract.pdf

id	iium-75487
recordtype	eprints
spelling	iium-754872019-12-17T01:49:00Z http://irep.iium.edu.my/75487/ The spine crasher: a challenging diagnosis Anuar, Muhamad Azamin Shaban Mohamed, Mossad Abdelhak Mohd Azhar, Nur Syuhada Abu Bakar, Asrar Hasan, Taufiq Hidayat RD701 Orthopedics RJ Pediatrics RJ101 Child Health. Child health services Spinal tuberculosis in children is an established preventable disease in developing countries. Complications are devastating due to its aptitude to cause bone destruction, spinal deformity and paraplegia. We present an eight-month old girl with isolated gross motor regression and evolving spastic paraplegia. It highlights the challenge we encountered due to delay in garnering the pertinent investigation. She presented to clinic with history of legs weakness and loss of rolling after a period of prolonged febrile illness. Both parents are medical practitioners. Mother had history of SVT during pregnancy in spite on anti-arrhythmic treatments. Her father is a thalassaemia carrier. A thorough examination revealed gross motor delay and upper motor neuron signs. She had raised inflammatory markers, anaemia and thrombocytosis with persistent low-grade temperature. CT brain with contrast showed meningeal enhancement. Full septic work up revealed the CSF result reflecting partially treated meningitis. She was treated with third generation cephalosporin and acyclovir. Mother claimed exposure to TB patients hence Mantoux test was recommended which came positive. Her chest x-ray, sputum culture, CSF culture and NAA studies came non-conclusive for pulmonary tuberculosis. MRI for brain and spine showed features of tuberculous spondylo-discitis of T4-T5 vertebrae with associated subligamentous paravertebral spread and epidural extension causing spinal cord compression and T3-T6 hydro-syringomyelia. After multidisciplinary team discussion, patient started on intensive antituberculosis regimen with good initial response. Clinically lower limbs power improved with good antigravity movement. Laboratory and radiological investigations have improved inflammatory markers and dropping trend thrombocytosis, and spinal gibbous stay stationary with improvement in plain radiology. She is under regular follow up awaiting serial MRI. 2019 Conference or Workshop Item NonPeerReviewed application/pdf en http://irep.iium.edu.my/75487/1/POSTER%20TB%20SPINE%20SYUHA%20PDF.pdf application/pdf en http://irep.iium.edu.my/75487/19/75487%20abstract.pdf Anuar, Muhamad Azamin and Shaban Mohamed, Mossad Abdelhak and Mohd Azhar, Nur Syuhada and Abu Bakar, Asrar and Hasan, Taufiq Hidayat (2019) The spine crasher: a challenging diagnosis. In: 5th Medical Research Symposium, 9th October 2019, Kuantan, Pahang. (Unpublished)
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English English
topic	RD701 Orthopedics RJ Pediatrics RJ101 Child Health. Child health services
spellingShingle	RD701 Orthopedics RJ Pediatrics RJ101 Child Health. Child health services Anuar, Muhamad Azamin Shaban Mohamed, Mossad Abdelhak Mohd Azhar, Nur Syuhada Abu Bakar, Asrar Hasan, Taufiq Hidayat The spine crasher: a challenging diagnosis
description	Spinal tuberculosis in children is an established preventable disease in developing countries. Complications are devastating due to its aptitude to cause bone destruction, spinal deformity and paraplegia. We present an eight-month old girl with isolated gross motor regression and evolving spastic paraplegia. It highlights the challenge we encountered due to delay in garnering the pertinent investigation. She presented to clinic with history of legs weakness and loss of rolling after a period of prolonged febrile illness. Both parents are medical practitioners. Mother had history of SVT during pregnancy in spite on anti-arrhythmic treatments. Her father is a thalassaemia carrier. A thorough examination revealed gross motor delay and upper motor neuron signs. She had raised inflammatory markers, anaemia and thrombocytosis with persistent low-grade temperature. CT brain with contrast showed meningeal enhancement. Full septic work up revealed the CSF result reflecting partially treated meningitis. She was treated with third generation cephalosporin and acyclovir. Mother claimed exposure to TB patients hence Mantoux test was recommended which came positive. Her chest x-ray, sputum culture, CSF culture and NAA studies came non-conclusive for pulmonary tuberculosis. MRI for brain and spine showed features of tuberculous spondylo-discitis of T4-T5 vertebrae with associated subligamentous paravertebral spread and epidural extension causing spinal cord compression and T3-T6 hydro-syringomyelia. After multidisciplinary team discussion, patient started on intensive antituberculosis regimen with good initial response. Clinically lower limbs power improved with good antigravity movement. Laboratory and radiological investigations have improved inflammatory markers and dropping trend thrombocytosis, and spinal gibbous stay stationary with improvement in plain radiology. She is under regular follow up awaiting serial MRI.
format	Conference or Workshop Item
author	Anuar, Muhamad Azamin Shaban Mohamed, Mossad Abdelhak Mohd Azhar, Nur Syuhada Abu Bakar, Asrar Hasan, Taufiq Hidayat
author_facet	Anuar, Muhamad Azamin Shaban Mohamed, Mossad Abdelhak Mohd Azhar, Nur Syuhada Abu Bakar, Asrar Hasan, Taufiq Hidayat
author_sort	Anuar, Muhamad Azamin
title	The spine crasher: a challenging diagnosis
title_short	The spine crasher: a challenging diagnosis
title_full	The spine crasher: a challenging diagnosis
title_fullStr	The spine crasher: a challenging diagnosis
title_full_unstemmed	The spine crasher: a challenging diagnosis
title_sort	spine crasher: a challenging diagnosis
publishDate	2019
url	http://irep.iium.edu.my/75487/ http://irep.iium.edu.my/75487/1/POSTER%20TB%20SPINE%20SYUHA%20PDF.pdf http://irep.iium.edu.my/75487/19/75487%20abstract.pdf
first_indexed	2023-09-18T21:46:49Z
last_indexed	2023-09-18T21:46:49Z
_version_	1777413504870907904

The spine crasher: a challenging diagnosis

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