A case of spinal tuberculosis presenting with cauda equina syndrome

Tuberculosis (TB) of the central nervous system accounts for only 1% of all cases of TB but 50% of these occur in the spine. Common clinical manifestations of spinal TB include fever, weight loss, back pain, lower limb weakness (either upper or lower motor neuron), and skeletal deformities such as kyphosis or gibbus. Infective pathology caused by Mycobacterium tuberculosis with epidural collection can present as acute cauda equina syndrome. Here, we describe a 28-year-old female patient who presented with low back pain and ascending weakness of both lower limbs (Medical Research Council grade 4/5 with absent ankle reflex) for 2 months with sudden-onset loss of bladder and bowel control for 1 day without any localized spinal tenderness, swelling, or discharging sinus in the back. Magnetic resonance imaging (MRI) spine was suggestive of an intraosseous collection with spondylodiscitis at the L4 level vertebral level. MRI can help identify the involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and the presence of vertebral column deformities making it a sensitive tool for the detection of spinal TB. Antituberculous treatment remains the cornerstone of treatment. Surgery is required in selected cases, for example, large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. A combined intervention of laminectomy with drainage of the collection with antitubercular therapy after microbiological evidence helped in the resolution of the patient's condition. Early diagnosis and appropriate treatment generally result in a good prognosis.