Abstract
Craniovertebral junction tuberculosis (CVJ TB) is a rare disease, potentially causing significant neurological deficits and even death. We report on a 80-year-old woman presenting with CVJ TB without pulmonary involvement. The diagnosis was made by biopsy of the cervical lymph node showing granulomatous caseation necrosis. Despite extensive erosion of the clivus, C1, and C2, and spinal cord compression, the patient was effectively managed with antituberculous drug therapy and conservative neck stabilization. Neck pain resulting from cervical spondylosis is common in elderly people. However, even if there is no obvious pulmonary involvement, CVJ TB should be considered in the differential diagnosis, especially in patients with painful neck stiffness. The most useful method available for evaluating this region is a combination of CT scan and MRI study. CVJ TB can be managed conservatively, except for a selected few cases, regardless of the extent of bony destruction.
Similar content being viewed by others
References
Mori T. Recent trends in tuberculosis, Japan. Emerg Infect Dis. 2000;6:56–566.
Gupta SK, Mohindra S, Sharma BS, Gupta R, Chhabra R, Mukherjee KK, et al. Tuberculosis of the craniovertebral junction: is surgery necessary? Neurosurgery. 2006;58:1144–50.
Teegala R, Kumar P, Kale SS, Sharma BS. Craniovertebral junction tuberculosis: a new comprehensive therapeutic strategy. Neurosurgery. 2008;63:946–55.
Raut AA, Narlawar RS, Nagar A, Ahmed N, Hira P. An unusual case of CV junction tuberculosis presenting with quadriplegia. Spine. 2003;28:E309.
Chadha M, Agarwal A, Singh AP. Craniovertebral tuberculosis: a retrospective review of 13 cases managed conservatively. Spine. 2007;32:1629–34.
Lifeso R. Atlanto-axial tuberculosis in adults. J Bone Joint Surg Br. 1987;69:183–7.
Hoffman EB, Crosier JH, Cremin BJ. Imaging in children with spinal tuberculosis. A comparison of radiography, computed tomography and magnetic resonance imaging. J Bone Joint Surg Br. 1993;75:233–9.
Krishnan A, Patkar D, Patankar T, Shah J, Prasad S, Bunting T, et al. Craniovertebral junction tuberculosis: a review of 29 cases. J Comput Assist Tomogr. 2001;25:171–6.
Fang D, Leong JC, Fang HS. Tuberculosis of the upper cervical spine. J Bone Joint Surg Br. 1983;65:47–50.
Kotil K, Dalbayrak S, Alan S. Craniovertebral junction Pott’s disease. Br J Neurosurg. 2004;18:49–55.
Sinha S, Singh AK, Gupta V, Singh D, Takayasu M, Yoshida J. Surgical management and outcome of tuberculous atlantoaxial dislocation: a 15-year experience. Neurosurgery. 2003;52:331–8.
Joint Tuberculosis Committee of the British Thoracic Society. Chemotherapy and management of tuberculosis in the United Kingdom: recommendations. Thorax. 1998;53:536–48.
Ramachandran S, Clifton IJ, Collyns TA, Watson JP, Pearson SB. The treatment of spinal tuberculosis: a retrospective study. Int J Tuberc Lung Dis. 2005;9:541–4.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Hoshino, C., Narita, M. Craniovertebral junction tuberculosis: a case report and review of the literature. J Infect Chemother 16, 288–291 (2010). https://doi.org/10.1007/s10156-010-0052-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10156-010-0052-x