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Paradoxical response in spinal tuberculosis: Lessons learnt.

Velivela K, Rajesh A - J Neurosci Rural Pract (2016 Apr-Jun)

Bottom Line: There was an improvement in the symptoms with weight gain and normalcy of appetite.However, all these patients had lymphopenia on differential leukocyte counts at the outset which normalized at 3 months.Surgical decompression and stabilization may be necessary in few cases who develop new neurological deficits or deformity or instability.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India.

ABSTRACT

Background: Patients with spinal tuberculosis started on antituberculous treatment (ATT) empirically and showing increasing size of the lesion on follow-up are a treatment challenge. We describe our experience in managing such cases.

Materials and methods: We treated 80 patients with spinal tuberculosis at our institute from January 2012 to June 2014. Of these, 50 were managed by surgical intervention and the rest 30 were managed conservatively only on anti-tubercular drugs. Six patients out of these 30 patients, showed a paradoxical increase in the size of lesion without any neurological deficits after 3 months of starting ATT. Surgical intervention was done in three cases, whereas other three were managed by ultrasound-guided tapping of the lesion with continuation of ATT.

Results: There was an improvement in the symptoms with weight gain and normalcy of appetite. However, all these patients had lymphopenia on differential leukocyte counts at the outset which normalized at 3 months.

Conclusion: The mainstay of management of paradoxical response in spinal tuberculosis should be conservative with drainage or aspiration of abscesses along with the continuation of ATT. Surgical decompression and stabilization may be necessary in few cases who develop new neurological deficits or deformity or instability.

No MeSH data available.


Related in: MedlinePlus

Serial images of patient 1 (a) sagittal and axial magnetic resonance images before starting antituberculous treatment (b) sagittal and axial magnetic resonance images showing paradoxical increase 3 months after starting antituberculous treatment (c) sagittal and axial magnetic resonance images showing resolution of lesion at completion of antituberculous treatment
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Figure 1: Serial images of patient 1 (a) sagittal and axial magnetic resonance images before starting antituberculous treatment (b) sagittal and axial magnetic resonance images showing paradoxical increase 3 months after starting antituberculous treatment (c) sagittal and axial magnetic resonance images showing resolution of lesion at completion of antituberculous treatment

Mentions: Among these 30 patients, on the first follow-up at 3 months, six patients complained of painless swelling in the paraspinal region. There were no neurological deficits in these patients and they had improved appetite with weight gain [Table 1]. As they presented with new onset fullness over the back, an MRI was done which revealed an increase in size of the spinal lesion with epidural/paraspinal collections in all the patients [Figures 1–3]. Their body weights increased and their erythrocyte sedimentation rate showed a decreasing trend. One peculiar observation that we noticed in retrospect was though they had normal total leukocyte counts, the differential counts had low lymphocytic counts at the outset, which increased at 3 months follow-up.


Paradoxical response in spinal tuberculosis: Lessons learnt.

Velivela K, Rajesh A - J Neurosci Rural Pract (2016 Apr-Jun)

Serial images of patient 1 (a) sagittal and axial magnetic resonance images before starting antituberculous treatment (b) sagittal and axial magnetic resonance images showing paradoxical increase 3 months after starting antituberculous treatment (c) sagittal and axial magnetic resonance images showing resolution of lesion at completion of antituberculous treatment
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4821926&req=5

Figure 1: Serial images of patient 1 (a) sagittal and axial magnetic resonance images before starting antituberculous treatment (b) sagittal and axial magnetic resonance images showing paradoxical increase 3 months after starting antituberculous treatment (c) sagittal and axial magnetic resonance images showing resolution of lesion at completion of antituberculous treatment
Mentions: Among these 30 patients, on the first follow-up at 3 months, six patients complained of painless swelling in the paraspinal region. There were no neurological deficits in these patients and they had improved appetite with weight gain [Table 1]. As they presented with new onset fullness over the back, an MRI was done which revealed an increase in size of the spinal lesion with epidural/paraspinal collections in all the patients [Figures 1–3]. Their body weights increased and their erythrocyte sedimentation rate showed a decreasing trend. One peculiar observation that we noticed in retrospect was though they had normal total leukocyte counts, the differential counts had low lymphocytic counts at the outset, which increased at 3 months follow-up.

Bottom Line: There was an improvement in the symptoms with weight gain and normalcy of appetite.However, all these patients had lymphopenia on differential leukocyte counts at the outset which normalized at 3 months.Surgical decompression and stabilization may be necessary in few cases who develop new neurological deficits or deformity or instability.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India.

ABSTRACT

Background: Patients with spinal tuberculosis started on antituberculous treatment (ATT) empirically and showing increasing size of the lesion on follow-up are a treatment challenge. We describe our experience in managing such cases.

Materials and methods: We treated 80 patients with spinal tuberculosis at our institute from January 2012 to June 2014. Of these, 50 were managed by surgical intervention and the rest 30 were managed conservatively only on anti-tubercular drugs. Six patients out of these 30 patients, showed a paradoxical increase in the size of lesion without any neurological deficits after 3 months of starting ATT. Surgical intervention was done in three cases, whereas other three were managed by ultrasound-guided tapping of the lesion with continuation of ATT.

Results: There was an improvement in the symptoms with weight gain and normalcy of appetite. However, all these patients had lymphopenia on differential leukocyte counts at the outset which normalized at 3 months.

Conclusion: The mainstay of management of paradoxical response in spinal tuberculosis should be conservative with drainage or aspiration of abscesses along with the continuation of ATT. Surgical decompression and stabilization may be necessary in few cases who develop new neurological deficits or deformity or instability.

No MeSH data available.


Related in: MedlinePlus