Multiple Drug-Resistant Lumbosacral Tuberculous Spondylitis in a Foreign-Born Immunocompetent Young Adult: A Case Report

The emergence of multiple drug-resistant strains of tuberculosis (MDR-TB) should be suspected if treatment failure occurs because globally its incidence is increasing. A 25-year-old Tibetan lama presented with a 2-month history of fistula formation over his low back and left thigh. He underwent wound debridement at another hospital with the diagnosis of cellulitis and osteomyelitis of the spine. On presentation, he was ambulatory with moderate back pain. MRI revealed lumbosacral spondylodiscitis, presacral abscess, and psoas abscess. With no clinical improvement after two weeks' 4-drug anti-TB chemotherapy, he underwent anterior corpectomy and fusion. Wound dehiscence developed one week postoperatively and debridement was repeated for three times. Profuse caseous discharge persisted in the following eight weeks despite the continued anti-TB regimen. Susceptibility tests performed during the last debridement proved to be mycobacterium tuberculosis resistant to INH and RIF. After shifting to second-line anti-TB drugs, both flank and thigh wounds healed rapidly. With the increasing prevalence of MDR-TB, the treatment of TB spondylitis must take into account the possibility of drug resistance especially in immigrants from TB-endemic countries and in patients having a history of anti-TB drug use or TB-related surgical procedures.

並列關鍵字

lumbosacral spondylitis ； multiple drug-resistance tuberculosis

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