AN UNUSUAL PRESENTATION OF EXTRAPULMONARY TUBERCULOSIS IN A HEMODIALYSIS PATIENT

Here, a fifty nine year old woman with extrapulmonary tuberculosis and pyogenic infection involving cervical spine is presented. The patient had chronic renal failure and was on maintenance hemodialysis for two years. She was on physiotherapy for neck pain when she suddenly developed weakness in both arms and difficulty in walking. Physical examination revealed stiffness in the neck, weakness in all extremities and two tender lymphadenopathies in the right supraclavicular area. In radiological examinations an epidural abscess with destruction of C5-C7 vertebral bodies was found. Histopathological examination of the biopsy from supraclavicular lymph nodes showed granulomatous lymphadenitis. The lungs were normal both clinically and also radiologically. She then underwent an operation and histopathology of the operation specimen showed similar granulomas containing Langhans type giant cells and central caseification together with a nonspecific pyogenic inflammation in the surrounding soft tissue. Medical therapy with antituberculosis agents and antibiotics was started and partial recovery was achieved.