A 78-year-old man with a history of Parkinsons disease treated with levodopa, seizure, and rasagiline, an invasive urothelial carcinoma that had been excised four years ago, was operated on for a positive s.
6 g daily for 21 days.
One year later, in a control, the patient complained of paresthesia in the lower limbs, progressive loss of strength and difficulty walking in the last three months, which made it impossible to walk at the time of consultation.
In addition, the family suffers from disorientation and mental disorders of 48 hours of evolution.
Since the surgical intervention she had presented several similar episodes, although of lower intensity, for which she had been studied in her reference hospital and ruled out a local infectious complication or other causal etiology, so she had been prescribed non-steroidal and symptomatic rehabilitation treatment.
On physical examination, the patient presented generalized loss of sensitivity in both lower extremities and a global muscle balance of 2/5.
The patient had a good general condition, fever and no other signs of toxic syndrome.
Magnetic resonance imaging (MRI) revealed a subacute spondylodyscitis D11-D12 accompanied by an inflammatory mass and an abscess for spinal canal stenosis medullary compression and abscess.
Laboratory tests showed a complete blood count with normal leukocyte and biochemical formula.
C-reactive protein (CRP) was 6.1 mg/dl (normal value < 0.5).
The patient was treated with dexamethasone, intravenous piperazilin/tazo arthrodesis 4.5 g every 6 h and vancomycin 1 g every 12 h, and surgery was scheduled.
During surgery, the presence of a granulomatous epidural and subcutaneous abscess was found, as well as partial somatic destruction of T11 and cutaneous manifestations.
Circumferential compression was performed after an extrahepatic lateral approach and T11-12 laminectomy.
Necrotic areas were found where hybridisation was performed on T11 and T12 bodies. Debridement was performed and ipsilateral arthrodesis was performed using autologous bone marrow from the iliac crest.
Tissue samples taken during the intervention were sent for current bacterial microbiological study and for Mycobacterium spp.
1.
Microbiological study
Biopsy and abscess samples received in the microbiology laboratory were grown for usual bacteria, slow growing bacteria and mycobacteria.
The usual culture for slow growing bacteria was negative after fifteen days of isolation.
As for the culture of mycobacteria, cultures were performed in liquid medium (BBL® MGIT®, BB Dickinson®). After solid acid staining was performed, the presence of alcohol in Mycobacterium tuberculosis was detected in 37 days.
In the solid culture medium was detected the presence of a colony with rough appearance, non-chromagenic and dysgonic growth.
It was confirmed that this was an AFAR, and then 9 pyrarentypic studies were conducted SIzins identification and resistance (GenoZA type MTBDR plus, Hain Livescience GmbH, NehECpeak, Germany) and rifampicin susceptibility to isoniazid (REambucomycin).
All these studies confirmed that the strain was M. tuberculosis complex sensitive to all anti-tuberculosis drugs tested except pyrazinamide.
Then, a homemade polymerase chain reaction (PCR) was performed based on the presence/absence of RD regions (regions of difference) in the mycobacterial genome to differentiate the members of the BCG complex.
Molecular diagnosis in the direct sample was performed with PCR FluoroType® MTB (in Livescience GmbH, Nehren, Germany).
The IGRA (interferon gamma release assay) was negative.
With the PCR for Mycobacterium tuberculosis complex in biopsy samples and positive abscesses two days after the surgical intervention, anti-tuberculosis treatment with isoniazid, rifampicin and et bamboo was started.
The patient was re-interrupted, who had received intravesical BCG facilities for three years after the surgical treatment for his tumor, and who had suffered a fever after one of the first instillations hr
On the days after the intervention, the strength of the lower limbs improved and the pain remained controlled, although it remained disoriented.
He had a good clinical evolution with progressive motor improvement of the right lower extremity.
Finally, the patient was admitted to a chronic patient hospital to continue rehabilitation.
A total of 12 months of anticancer therapy was completed.
Currently, after two years of follow-up, he barely complained of back discomfort and presented an objective and subjective improvement of strength in the left lower limb.
