Spontaneous atraumatic fracture of a cervical vertebra in tuberculosis: a case report

Abstract

IntroductionSpontaneous pathological fractures of the cervical spine due to tuberculosis are rare. But with escalating incidences of atypical presentations of tubercular disease, clinicians should exercise a high index of suspicion for early diagnosis of such cases.Case presentationWe present a case of a 50-year-old Hindu man from northern India, who complained of pain and stiffness in his neck. His radiographs showed a fracture in his second cervical vertebral body. But further investigations raised the suspicion of an infective pathology, which was corroborated by magnetic resonance imaging and fine needle aspiration cytology. His symptoms improved and the fracture healed following antitubercular chemotherapy and immobilization.ConclusionIn endemic regions like India, clinicians should be on the lookout for atypical presentations of tuberculosis. Any suspicious lesion should be evaluated with care for clinical, radiological and laboratory evidences of the infection. The affected spine should be protected and appropriate chemotherapy should be instituted at the earliest opportunity.

Mother's iliac bone graft for severe collapsed lumbar tuberculosis: A case report

“…Antituberculosis chemotherapy should be started as early as possible, and an empirical antituberculosis treatment program is required before the etiologic diagnosis is established. 12,13 In contrast, surgical treatment of tuberculosis has long been controversial. The usual indications for surgical intervention are progressive neurological deficits, ineffective conservative treatment, spinal instability, deformities, drug resistance to drain the abscess and willingness to accept abscess incision and drainage, as well as in cases of diagnostic suspicion where the tumor cannot be excluded.…”

“…The goal of treatment for spinal tuberculosis is to destroy the infection, provide stability to the invaded spine, and prevent or treat paralysis by supportive care, chemotherapy, and surgery. Antituberculosis chemotherapy should be started as early as possible, and an empirical antituberculosis treatment program is required before the etiologic diagnosis is established 12,13 . In contrast, surgical treatment of tuberculosis has long been controversial.…”

Woman with agonal breathing

“… 2 There are few case reports of spontaneous atraumatic cervical fracture due to tuberculosis or rheumatoid arthritis. 3 , 4 High‐level SCI causes impairment of respiratory muscles and reduces vital capacity and chest wall compliance. It also influences the respiratory drive, leading to hypercapnia.…”

“…Non‐traumatic SCI is a rare neurological emergency 2 . There are few case reports of spontaneous atraumatic cervical fracture due to tuberculosis or rheumatoid arthritis 3,4 . High‐level SCI causes impairment of respiratory muscles and reduces vital capacity and chest wall compliance.…”