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Subject Area

Infection

Document Type

Case Report

Abstract

Background Data: Spine is the most common site of extrapulmonary tuberculosis. Among the various spine segments, isolated involvement of the sacrum is the rarest presentation. A high index of suspicion is needed to diagnose and treat it.

Purpose: We present the findings of a presacral cystic lesion found to be tubercular because of its unusual presentation explaining the diagnostic difficulty, management, and outcomes.

Study Design: This is a case report and literature review.

Patients and Methods: We report a 12-year-old female child presenting with low back ache radiating to both thighs, difficulty in ambulation, and swelling in the right gluteal region. Imaging revealed a large well-defined CSF intense cystic lesion consistent with presacral meningocele. The patient was taken for lower midline laparotomy and repair of the meningocele. Intraoperatively, 500 mL of greenish-yellow pus was evacuated on opening the cyst. The nucleic acid amplification test of pus was positive for Mycobacterium tuberculosis.

Results: The patient ran a smooth postoperative course, and her symptoms improved.

Conclusion: Sacral tuberculosis is rare. Early diagnosis for these lesions is challenging, but results are highly satisfactory if done with proper planning and meticulous surgical techniques.

Keywords

Sacral spine, Tuberculosis, Meningocele

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