gms | German Medical Science

Objective: For long time tuberculous infections (TBI) were a rare entity in industrialized countries. In recent times it becomes more relevance because of increased population mobility including migration und travelling. TBI causes 2 - 3 million deaths annually worldwide.

A severe form of extrapulmonary TBI is the craniocervical tuberculous infection. In this case report we describe such a rare entity of tuberculous infection of the cervical spine.

Method: Patients with craniocervical TBI are rare, thus we refer to a single patient who presented in our emergency ward with an unclear tumour in the MRI-scan at C1/2 level. Clinical symptoms of the male 31-year-old patient of brasilian origin were neckpain and mild ataxia. No other neurological deficits were present. We undertook a charge of diagnostics: The x-ray of the thorax showed no focal rounded pulmonary opacities. A CT-scan of the neck showed infiltration of the bone with osteolytic changes. We performed a CT-punction, where we could not find any tumourcells apart from necrotic tissue. An additional F18-FDG-PET/CT revealed two foci with high metabolic rate in the lung. In order to obtain material for histologic and microbiological investigation a bronchoscopy was undertaken. The PCR probe was positive for M. tuberculosis. We started tuberculostatic therapy with Moxifloxacin, Ethambutol, Pyrazinamid and Rifampicin. We decided on a conservative treatment with regular controlling CT-scans and immobilization therapy with a stiff neck. However the patient was incompliant for constantly wearing the stiff neck. A follow-up CT-scan showed an atlanto-axial dislocation and progression of the osteolytic process at C1/2 level together with subluxion of the odontoid process into the Foramen magnum. We decided to install a Halo-Fixateur in order to stabilize and retract the malposition at C1/2.

Results: A new F18-FDG-PET/CT in order to quantify the metabolic activity of the infectious process showed decreasing activity. The malposition is partially improved by the retraction of the Halo-Fixateur. Pain is currently under control. No further neurologic deficits occurred.

Conclusions: Craniocervical TBI is a rare manifestation of the disease. The literature does not give clear advice how to treat it. If instability and malposition of the craniocervical spine occur, an operative stabilization can be performed in addition to the immobilization and tuberculostatic therapy.