Management Of Rare Spinal Tuberculosis During Pregnancy – Part I

Tuberculosis of the spine also known as Tuberculous psoas abscess in pregnancy is cited to be uncommon with the accounted incidents depending on the endeavours undertaken to identify it. Yet, the occurrence of relapse in past tuberculosis among pregnant patients is reported at being nearly twenty-seven percent.

Tuberculosis of the spine is the highly prevalent and lethal form of tuberculosis infection and a prompt, timely detection is crucial as postponement in diagnosis and management leads to an array of complications like spinal cord compression, deformity and might escalate to paraplegia or quadriplegia depending on the location affected.

The below stated cites the case report of psoas abscess detected in a woman during pregnancy at fifteen weeks of gestation and the successful line of treatment followed.

A twenty-one year old married primigravida woman during fifteen weeks gestation was admitted to a hospital with difficulty experienced during walking and pain felt in the right hip joint that persisted since the past two to three weeks. The woman had no history of abdominal pain, fever and difficulty in micturating or passing faeces. The first trimester passed uneventfully. The woman had no past tuberculosis and family history too wasn’t significant.

During abdominal check-up, the uterus was sixteen weeks size. During vaginal examination, an obscure non-tender mass was noted posterior to the uterus. Cervical movement was not seen being transmitted to the mass. Quandary at the time of diagnosis continued as the ultrasound examination showed a sole live foetus that was fifteen weeks gestation with an elliptical mass of size 16.7 by 8.6 centimetres located next to the left ovary with cystic, solid constituents indicative of ovarian mass or a cystic disintegrated fibroid.

Due to futile clinical examination that did not point to an ovarian mass or a fibroid and the patient mainly complaining of back pain and trouble during walking; a spinal pathology was supposed. The MRI scan of the lower part of the abdomen and sacroiliac joint was counselled and an orthopedic consultation was undertaken. An MRI scan proved to help confirm the doctor’s doubts. The MRI scan detected caries of the spine that involved the lower dorsal, lumbar and sacral vertebras alongside the involvement of the iliac bone with massive two-sided psoas abscesses with the left sided one being larger than the right side and pus formation and granulation tissue were noted to be present within the spine.

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