Diagnostic Dilemma

Epidural and psoas abscess

A 4½ years old girl presented with fever and frontal headache for 15 days with lower limb tightness for 10 days. Her physician did a cerebrospinal fluid analysis that showed 3900 cells, hpf {78 percent polymorphs, 22 percent lymphocytes} for which Vancomycin and Piperacillin, Tazobactum were started but fever persisted. MRI brain and spine showed intraspinal abscess in cervical region with left psoas abscess and loculated pleural effusion. Complete blood count {CBC} showed hemoglobin of 9.9 gm, dl, white blood cell {WBC} count of 5,800, cumm {polymorphs 36 percent, lymphocytes 60 percent and eosinophils 4 percent}, ESR of 110 mm at end of 1 hour. Mantoux test and HIV Elisa were negative. Sputum for acid fast bacillus {AFB} was also negative. Anti TB treatment {ATT} was started consisting of Isoniazid {H}, Rifampicin {R}, Pyrazinamide {Z} and Ethambutol {E} with steroids {2 mg, kg, day}. With anti-tuberculous therapy {ATT} her fever resolved and a repeat MRI spine after one month showed resolution of epidural cervical abscess as well as the psoas abscess.

Is this really tuberculosis_?
Expert Opinion :
It is possible that there was a gram positive bacterial infection that could have caused the meningitis as well as abscesses and addition of Rifampicin could have led to resolution.
Besides Piperacillin tazobactum does not cross the blood brain barrier and hence it is likely the child did not respond initially.

Since there was response to ATT, one could say that the child had TB but there is no conclusive evidence for the same.
Answer Discussion :
its dissemination of the tb rather than pulmonary tb, pott disease , spine tb
7 years ago
dassienoubibo jeanmichel
yes,multi local TB in context of immunodeficiency{ no response for mantoux }
7 years ago

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