Tubercular Epidural Abscess in Cervical Spine Without Bony Involvement in a Patient With HIV Coinfection

Abstract

Spinal epidural abscess (SEA) represents a severe, generally pyogenic, infection of the epidural space, which compresses the neural elements and requires urgent surgical decompression to avoid permanent neurological deficit. Tubercular SEA without bony involvement is very rare and has not been reported in patients with human immunodeficiency virus (HIV) infection. We present a rare case of SEA of tubercular origin in the cervical spine without bony involvement in a patient with HIV infection. A 35-year-old HIV-positive female presented with neck pain, rapid-onset quadriparesis with urinary retention. Magnetic resonance imaging showed a cervical ventrally placed epidural collection enhancing on contrast, without bony involvement, suggestive of epidural abscess. The pus was drained through the anterior cervical approach. Histopathology revealed multiple acid-fast bacilli, suggestive of tubercular infection. The patient made an uneventful recovery after surgical decompression and antitubercular treatment. SEA due to tuberculosis in absence of bony involvement is extremely rare in patients with HIV Infection. Early diagnosis followed by urgent surgical decompression combined with antituberculous drugs lead to good outcome in these patients.