Extrapulmonary tuberculosis is more common in
end-stage renal disease than in normal subjects, and it frequently poses both diagnostic and therapeutic challenges. We describe 2 dialysis patients with
tuberculosis of the spine (
Pott's disease). The 1st patient presented with back and left hip
pain, low-grade
fever, left-quadriceps weakness,
hypoesthesia of the left thigh, and hypoactive left-knee jerk. X-rays of the spine showed only
osteophytes. Magnetic resonance imaging showed increased signal intensity of L3 with focal expansion into the spinal canal. A computerized tomography guided biopsy revealed
granulomas, and Ziehl-Neelsen
stain was positive.
Therapy with
rifampin,
isoniazid,
ethambutol, and
pyrazinamide caused
peripheral neuropathy and
optic neuritis. The 2nd patient developed bilateral proximal thigh
pain and weakness that progressed to
paraplegia. Magnetic resonance imaging showed destructive lesion of L3-5, involving both psoas muscles, prevertebral space, and neural foramina. Ziehl-Neelsen
stain of the biopsy specimen was negative, but culture was positive for Mycobacterium tuberculosis.
Paraplegia improved only partially after 1 year of
therapy.
Pott's disease should be suspected in
end-stage renal disease patients with
back pain and/or neuromuscular complaints, particularly in those who immigrated from Asian and Latin-American countries. Treatment of
tuberculosis in dialysis patients may cause significant morbidity.