Difficulties in the Diagnosis of Extrapulmonary Tuberculosis on a Refugee Teenager. A Case Report

Background: Over recent years in France, the rate of tuberculosis remains stable with a declining tendency. 12.9% of tuberculosis cases concern teenagers and young adults from 15 to 24 years-old.

Objective: To reveal the importance of Polymerase chain reaction (PCR) in the diagnosis of bone tuberculosis.

Methods: A case report of a teenager with bone tuberculosis

Results: A 17-year-old Somalian boy without medical history was referred to our pediatric department with a 3-month history of fever, abdominal pain, vomiting, diarrhea, dysphagia to solids and serious anorexia. Refugee, his BCG vaccination status was unknown. He appeared unwell with dyspnea class II NYHA, bilateral inguinal and cervical painless lymphadenopathy. Pulmonary auscultation found decreased breath sounds on right lung. The C-reactive protein level was 57.4mg/L. The thoracic computed tomography (CT) found medium lobar consolidation with right-sided pleural nodules and bilateral inguinal lymphadenopathy. An abdominopelvic CT scan confirmed a 6-centimeter abscess in the spinal canal (T11-T12) and a 2-centimeter cystic lesion in the left iliac crest. QuantiFERON was positive. Neither a tuberculin purified protein derivative test nor a chest XR were performed. Expectorated sputum and gastric catheterization showed no sign of Mycobacterium tuberculosis (MT). First bone biopsy under local anesthesia failed due to pain and lack of patient cooperation. Meanwhile symptoms worsened. Any movement of the left hip became unbearable especially at night and while exercising. Lumbar spine and pelvic MRI revealed spondylitis involving T12, cold epidural and paravertebral abscess with compression sign and a cystic lesion of the right-sided sacrum. As the neurological exam was normal, no surgical decompression was recommended. A second biopsy was scheduled under general anesthesia. PCR confirmed MT, sensitive to rifampin. The patient regained normal function within a month.

Conclusion: PCR was very useful for the diagnosis of bone tuberculosis of a spinal lesion.