Pediatric paraparesis: Radiological challenges in multidrug-resistant tuberculous spondylitis based on experience in Indonesia

TL;DR

This paper discusses the role of radiology in diagnosing and managing multidrug-resistant tuberculosis in a child's spine, emphasizing its importance in preventing disability.

Contribution

The paper highlights the critical role of multimodal radiological imaging in diagnosing and managing pediatric tuberculous spondylitis in a developing country.

Findings

Radiological exams revealed extensive spinal disease and neurological deficits in a 20-month-old child.

Combining radiology with clinical collaboration is vital for timely intervention in pediatric cases.

Early diagnosis through imaging helps prevent severe complications in multidrug-resistant tuberculosis.

Abstract

Multidrug-resistant tuberculous spondylitis is a global health issue, especially in developing nations, and non-specific symptoms lead to delay in identification, treatment, and potential disability in children. Radiology plays a crucial role in diagnosing tuberculous spondylitis, which in turn might lead to effective treatment, prevention of disability and improved patient outcomes. Our case involved a 20-month-old malnourished child presented with paraparesis, revealing a history of contact with parental multidrug-resistant tuberculosis. Multimodality radiological examinations, including conventional radiography, CT, and MRI revealed extensive disease of the spine with disc involvement, large paravertebral abscess, and kyphotic deformity which produced neurological deficits, necessitating both anti-tuberculosis regimen and surgical intervention. Radiological examinations have a pivotal role in diagnosing, evaluating and guiding timely management of multidrug-resistant tuberculous spondylitis. Prompt diagnosis of the condition is crucial in order to prevent potentially severe complications, which contribute significantly to morbidity. Our case demonstrated the importance of radiology in diagnosing extensive spine involvement of the disease causing neurological deficits. Furthermore, radiology also helps in managing tuberculous spondylitis to prevent future disability in a child patient of a developing country. This case highlights the crucial significance of radiological imaging in the diagnosis and management of pediatric tuberculous spondylitis in impoverished nations. The patient's complex medical history highlights the socioeconomic factors contributing to tuberculosis burden. Early and comprehensive radiological assessment, together with collaboration between radiologists and clinicians, is vital for timely intervention and improved outcomes in pediatric tuberculous spondylitis cases to prevent the impact of this debilitating disease on children.

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