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Special Feature
September 7, 2009

Picture of the Month—Diagnosis

Arch Pediatr Adolesc Med. 2009;163(9):864. doi:10.1001/archpediatrics.2009.146-b

Cranial and vertebral magnetic resonance imaging revealed destruction of the second thoracic vertebra and a major paravertebral abscess, causing cord compression, which suggests tuberculous spondylitis. The diagnosis of Mycobacterium tuberculosiswas confirmed by polymerase chain reaction assay on samples of the cutaneous lesion biopsy material and dorsal abscess. After 2 months of taking 4 antituberculous drugs, the patient completed 16 months of treatment with isoniazid and rifampin.

Computed tomography–guided abscess drainage was initially performed, which resulted in a partial reduction in abscess volume. During the second week of therapy, the patient underwent anterior debridement and drainage through costotransversectomy and posterior spinal–instrumented fusion. The patient had an uneventful recovery, regaining normal gait with full motor strength in both lower extremities. Complete healing of the cutaneous ulcer was achieved after 8 weeks of treatment, and spinal fusion was documented at 12 months.