Nonoperative management of craniovertebral junction and cutaneous tuberculosis

Abstract

Background:Craniovertebral junction (CVJ) and cutaneous tuberculosis (TB) are both rare, each occurring in 0.3–1.0% of patients. To our knowledge, there are no existing cases reporting these manifestations of TB simultaneously. We report a case of TB involving the left CVJ as well as the skin, and discuss our management while providing a review of the literature.Case Description:An adult patient was presented with progressive nocturnal neck pain associated with the development of several skin lesions. Investigations revealed multiple osseous lesions including the left CVJ. Biopsy of the CVJ lesion was unamenable due to proximity of the vertebral artery; therefore, the patient underwent biopsy of the other sites. Histological examination demonstrated features consistent with TB infection and the patient commenced 12 months of standard anti-TB therapy with cervical spine immobilization. At 2-month review, the patient was well with a near-complete resolution of neck pain and cutaneous lesions. Repeat imaging at 6 months follow-up demonstrated a stable C1 lesion with no evidence of instability.Conclusion:CVJ TB may be treated solely with anti-TB therapy and immobilization to good effect if there is no gross instability or neurological deficit. Similarly, cutaneous TB responds well to standard anti- TB therapy. Our experience suggests that co-existing tuberculous lesions in the CVJ and skin can be simultaneously managed with standard therapy without significant alterations to treatment regimes or prognosis.

Occipital condyle syndrome in a case of rotatory atlantoaxial subluxation (type II) with craniovertebral junction tuberculosis: Should we operate on “active tuberculosis?”

“…highlighted the nonoperative management for CVJ tuberculosis and wrote that tissue biopsy is helpful only where drug-resistant tuberculosis is suspected. [ 21 ] In our experience, a contrast-enhanced MRI with ESR and lymphocytosis is sufficient to diagnose and start treatment. A clinical improvement, particularly a sharp decrease in the pain along with overall improvement in general health, indicates a good response to ATT, even in the face of unchanged radiology.…”