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Sekarsari D, Handoyono QF, Amal MY, Maharani MAP, Hendriarto A. Pediatric paraparesis: Radiological challenges in multidrug-resistant tuberculous spondylitis based on experience in Indonesia. Radiol Case Rep 2024; 19:3287-3293. [PMID: 38812598 PMCID: PMC11133498 DOI: 10.1016/j.radcr.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 05/31/2024] Open
Abstract
Multidrug-resistant tuberculous spondylitis is a global health issue, especially in developing nations, and non-specific symptoms lead to delay in identification, treatment, and potential disability in children. Radiology plays a crucial role in diagnosing tuberculous spondylitis, which in turn might lead to effective treatment, prevention of disability and improved patient outcomes. Our case involved a 20-month-old malnourished child presented with paraparesis, revealing a history of contact with parental multidrug-resistant tuberculosis. Multimodality radiological examinations, including conventional radiography, CT, and MRI revealed extensive disease of the spine with disc involvement, large paravertebral abscess, and kyphotic deformity which produced neurological deficits, necessitating both anti-tuberculosis regimen and surgical intervention. Radiological examinations have a pivotal role in diagnosing, evaluating and guiding timely management of multidrug-resistant tuberculous spondylitis. Prompt diagnosis of the condition is crucial in order to prevent potentially severe complications, which contribute significantly to morbidity. Our case demonstrated the importance of radiology in diagnosing extensive spine involvement of the disease causing neurological deficits. Furthermore, radiology also helps in managing tuberculous spondylitis to prevent future disability in a child patient of a developing country. This case highlights the crucial significance of radiological imaging in the diagnosis and management of pediatric tuberculous spondylitis in impoverished nations. The patient's complex medical history highlights the socioeconomic factors contributing to tuberculosis burden. Early and comprehensive radiological assessment, together with collaboration between radiologists and clinicians, is vital for timely intervention and improved outcomes in pediatric tuberculous spondylitis cases to prevent the impact of this debilitating disease on children.
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Affiliation(s)
- Damayanti Sekarsari
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No. 4, Senen, Central Jakarta, DKI Jakarta
| | - Quinta Febryani Handoyono
- Department of Radiology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No. 4, Senen, Central Jakarta, DKI Jakarta
| | - Mohamad Yanuar Amal
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No. 4, Senen, Central Jakarta, DKI Jakarta
| | - Maria Angela Putri Maharani
- Department of Anatomic Pathology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No. 4, Senen, Central Jakarta, DKI Jakarta
| | - Andra Hendriarto
- Department of Orthopedics and Traumatology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No. 4, Senen, Central Jakarta, DKI Jakarta
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Pott's disease associated with psoas abscess: Case report. Ann Med Surg (Lond) 2022; 74:103239. [PMID: 35070289 PMCID: PMC8761608 DOI: 10.1016/j.amsu.2021.103239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 11/21/2022] Open
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Letter to the Editor Regarding "Langerhans Cell Histiocytosis Involving Second Cervical Vertebra and the Hypothalamus and Pituitary in Adult; A Case Report". World Neurosurg 2021; 143:587-588. [PMID: 33167123 DOI: 10.1016/j.wneu.2020.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 11/22/2022]
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Spekker O, Kis L, Deák A, Makai E, Pálfi G, Váradi OA, Molnár E. An unusual case of childhood osteoarticular tuberculosis from the Árpádian Age cemetery of Győrszentiván-Révhegyi tag (Győr-Moson-Sopron county, Hungary). PLoS One 2021; 16:e0249939. [PMID: 33852636 PMCID: PMC8046221 DOI: 10.1371/journal.pone.0249939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/27/2021] [Indexed: 02/06/2023] Open
Abstract
Ancient human remains exhibiting bony changes consistent with osteoarticular tuberculosis (OATB) indicate that the disease has afflicted mankind for millennia. Nonetheless, not many pediatric OATB cases have been published in the paleopathological literature–from Hungary, only three cases have been described up to now. In our paper, we demonstrate a child (S0603) from the Árpádian Age cemetery of Győrszentiván-Révhegyi tag (northwestern Hungary), who represents a unique case of OATB regarding both the pattern and severity of the observed bony changes. During the macromorphological and radiological investigations, the most serious alterations were discovered in the upper thoracic spine–the development of osteolytic lesions led to severe bone loss and consequent collapse and fusion of several adjacent vertebrae. The pathological process terminated in a sharp, rigid angular kyphosis. Disruption of the normal spine curvature resulted in consequent deformation of the whole thoracic wall–it became “rugby-ball-shaped”. The overall nature and pattern of the detected alterations, as well as their resemblance to those of described in previously published archaeological and modern cases from the pre-antibiotic era indicate that they are most consistent with OATB. Based on the severity and extent of the lesions, as well as on the evidence of secondary healing, S0603 suffered from TB for a long time prior to death. Besides body deformation, OATB resulted in consequent disability in daily activities, which would have required regular and significant care from others to survive. It implies that in the Árpádian Age community of Győrszentiván-Révhegyi tag, there was a willingness to care for people in need. Detailed archaeological case studies can give us a unique insight into the natural history and different presentations of OATB. Furthermore, they can provide paleopathologists with a stronger basis for diagnosing TB and consequently, with a more sensitive means of assessing TB frequency in past populations.
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Affiliation(s)
- Olga Spekker
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- * E-mail:
| | - Luca Kis
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - Andrea Deák
- Rómer Flóris Museum of Art and History, Győr, Hungary
| | - Eszter Makai
- Department of Radiology, University of Szeged, Szeged, Hungary
| | - György Pálfi
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - Orsolya Anna Váradi
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- Department of Microbiology, University of Szeged, Szeged, Hungary
| | - Erika Molnár
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
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