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The spine crasher: a challenging diagnosis

Anuar, Muhamad Azamin and Shaban Mohamed, Mossad Abdelhak and Mohd Azhar, Nur Syuhada and Abu Bakar, Asrar and Hasan, Taufiq Hidayat (2019) The spine crasher: a challenging diagnosis. In: 5th Medical Research Symposium, 9th October 2019, Kuantan, Pahang. (Unpublished)

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Spinal tuberculosis in children is an established preventable disease in developing countries. Complications are devastating due to its aptitude to cause bone destruction, spinal deformity and paraplegia. We present an eight-month old girl with isolated gross motor regression and evolving spastic paraplegia. It highlights the challenge we encountered due to delay in garnering the pertinent investigation. She presented to clinic with history of legs weakness and loss of rolling after a period of prolonged febrile illness. Both parents are medical practitioners. Mother had history of SVT during pregnancy in spite on anti-arrhythmic treatments. Her father is a thalassaemia carrier. A thorough examination revealed gross motor delay and upper motor neuron signs. She had raised inflammatory markers, anaemia and thrombocytosis with persistent low-grade temperature. CT brain with contrast showed meningeal enhancement. Full septic work up revealed the CSF result reflecting partially treated meningitis. She was treated with third generation cephalosporin and acyclovir. Mother claimed exposure to TB patients hence Mantoux test was recommended which came positive. Her chest x-ray, sputum culture, CSF culture and NAA studies came non-conclusive for pulmonary tuberculosis. MRI for brain and spine showed features of tuberculous spondylo-discitis of T4-T5 vertebrae with associated subligamentous paravertebral spread and epidural extension causing spinal cord compression and T3-T6 hydro-syringomyelia. After multidisciplinary team discussion, patient started on intensive antituberculosis regimen with good initial response. Clinically lower limbs power improved with good antigravity movement. Laboratory and radiological investigations have improved inflammatory markers and dropping trend thrombocytosis, and spinal gibbous stay stationary with improvement in plain radiology. She is under regular follow up awaiting serial MRI.

Item Type: Conference or Workshop Item (Poster)
Additional Information: 8392/75487
Uncontrolled Keywords: spinal tuberculosis, gross motor delay,
Subjects: R Medicine > RD Surgery > RD701 Orthopedics
R Medicine > RJ Pediatrics
R Medicine > RJ Pediatrics > RJ101 Child Heatlh. Child health services. Preventive health services for children
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): Kulliyyah of Medicine
Depositing User: Dr Muhamad Azamin Anuar
Date Deposited: 17 Dec 2019 09:49
Last Modified: 17 Dec 2019 09:49
URI: http://irep.iium.edu.my/id/eprint/75487

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