Isolated Spontaneous Primary Tubercular Erector Spinae Abscess: A Case Report and Review of Literature

Abstract

Isolated spontaneous primary tubercular erector spinae abscess in an immunocompetent patient is very rare. Here, we report such a case of 21-year-old female, which was successfully managed with timely diagnosis and intervention. Isolated primary tubercular abscess of erector spinae is a rare differential diagnosis of low back pain; however, it must be suspected in an endemic region for tuberculosis, especially when raised erythrocytic sedimentation rate and C-reactive protein are present. Excision along with anti tubercular therapy proved to be a successful strategy in our patient.

Author Response: Isolated Spontaneous Primary Tubercular Erector Spinae Abscess: A Case Report and Review of Literature

“…We would like to mention here that the case reported by Indudhara et al [ 1 ] was on renal transplant recipient with tubercular pyomyositis of left erector spinae muscle. This is totally a different case scenario from our case [ 3 ], as patient was a renal transplant recipient and had immuno-compromised status. It has already been documented in the literature that risk of dissemination and extraskeletal tuberculosis is more in immunocompromised patients [ 4 ].…”

“…It has already been documented in the literature that risk of dissemination and extraskeletal tuberculosis is more in immunocompromised patients [ 4 ]. In our case [ 3 ], the patient was immunocompetent young female, who had spontaneous onset of lower back pain. Moreover, our case signifies that magnetic resonance imaging is non-invasive diagnostic modaltiy of choice in such cases as it gives much better details of the diseases affecting soft tissues.…”

“…We do agree that injection of muscular tissue by the tubercular bacilli without coexistence of active skeletal and extraskeletal tuberculosis is an event of rare occurrence. However, anti-tubercular multi drug therapy with or without surgical intervention (aspiration/incision and drainage) is the treatment of choice and has shown consistent results in the past [ 1 2 3 5 ].…”

Erector Spinae Tubercular Abscess

“…We have read with great interest the case report entitled, "Isolated Spontaneous Primary Tubercular Erector Spinae Abscess: A Case Report and Review of Literature" in the issue of Asian Spine J 2015;9(2):276-280 doi: 10.4184/asj.2015.9.2.276 and we would like to congratulate the authors on their management of the case. However, we would like to make some comments, which we believe will advance the potential contribution of this study [ 1 ].…”

“…1. The authors state that until date, there has been only one report [ 2 ] on isolation of spontaneous primary tubercular erector spinae abscess [ 1 ]. We agree with the authors but we would like to draw attention towards one additional case report related with erector spinae tubercular abscess in a renal-transplant recipient [ 3 ].…”