Occurrence of multidrug-resistant tuberculous meningitis associated with injury during spinal surgery: A case report

• Main Authors: Mingwei Zhao (Author), Ling Liu (Author), Miao Wang (Author), Weidong Zhou (Author), Minglei Zhang (Author), Han Xiao (Author), Yu Pang (Author)
• Format: Book
• Published: Elsevier, 2020-10-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1876-0341; 10.1016/j.jiph.2020.05.022
• Keywords: Mycobacterium tuberculosis; Spine; Multidrug-resistance; Tuberculous meningitis; Infectious and parasitic diseases; RC109-216; Public aspects of medicine; RA1-1270
• Source: Journal of Infection and Public Health, Vol 13, Iss 10, Pp 1586-1588 (2020)

Here we describe a case of multidrug-resistant tuberculous meningitis associated with injury inflicted during spinal surgery. A 54-year-old man was diagnosed with multidrug-resistant spinal tuberculosis (TB). Anterior debridement and fusion with posterior fusion and instrumentation were conducted to remove damaged bone and TB-associated granulomatous tissue. After surgical decompression, a lancet wound (about 5 mm in length) was discovered in the cerebral dura mater at the L3 position of the vertebral body. At four weeks post-surgery, the patient experienced fever, hemiparesis, and aphasia. Cerebrospinal fluid (CSF) findings were consistent with TB meningitis, while in vitro susceptibility test results confirmed that the patient had multidrug-resistant TB. Our data highlight a possible TBM infection associated with a surgical lesion in a spinal TB patient. Rapid molecular diagnostics are urgently needed to formulate efficacious regimens for treating these patients.