Ann Rehabil Med.  2014 Jun;38(3):405-409. 10.5535/arm.2014.38.3.405.

Paralysis Developing as a Paradoxical Response During the Treatment for Tuberculous Spondylitis: A Case Report

• Park JH
• Kim YH
• Kwon CH
• Shin HI

• KMID: 2165761
• DOI: http://doi.org/10.5535/arm.2014.38.3.405

Abstract

It can be difficult for clinicians to distinguish a paradoxical response to antituberculous therapy, worsening of an existing lesion despite adequate treatment, treatment failure, and drug resistance. We report a case of a 69-year-old woman who experienced bilateral lower extremity paralysis secondary to a paradoxical response. She had been suffering for 1 month from low back pain, due to tuberculous spondylitis. Her low back pain improved after antituberculous therapy. The low back pain, however, reappeared 2 months after treatment, accompanied by newly developed lower extremity weakness. Imaging studies showed an increased extent of her previous lesions. Consequently, the patient underwent a vertebral corpectomy with interbody fusion of the thoracolumbar spine. Histopathological examination showed chronic inflamed granulation tissue with no microorganisms. Although the antituberculous medication was not changed, the patient's symptoms and signs, including the paralysis, resolved after surgery.

Keyword

Paradoxical response; Spinal tuberculosis; Paralysis

MeSH Terms

Aged
Drug Resistance
Female
Granulation Tissue
Humans
Low Back Pain
Lower Extremity
Paralysis*
Spine
Spondylitis*
Treatment Failure
Tuberculosis, Spinal

Figure

• 

  Fig. 1 Gadolinium-enhanced fat-suppressed T1-weighted magnetic resonance images of the spine. Before antituberculosis therapy, images revealed low signal changes in the T12 and L1 vertebra body with intense enhancement in the sagittal (A) and axial planes (B). At 95 days after appropriate anti-tuberculosis therapy, images showed increased T12-L3 inflamed tissue, resulting in more central canal compromise and cord compression in the sagittal (C) and axial planes (D). Arrows indicate key findings.

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