Hao Zhang1, Dadi Jin. 1. Department of Orthopaedic and Spinal Surgery, Nanfang Hospital, Guangzhou, China. zhhaohk@yahoo.com
Abstract
STUDY DESIGN: A case is reported. OBJECTIVES: To report and discuss a case of multiple cystic tuberculous skeletal lesions. SUMMARY OF BACKGROUND DATA: Multiple cystic tuberculosis lesions of the skeleton, or Jüngling disease, is a rare variety of tuberculosis reported extensively 30 to 40 years ago. No such severe type of tuberculosis has been reported in recent years. The patient was a 43-year-old woman with a history of steroid treatment, whose cervical lesions caused C2 and C3 destruction and spinal cord impingement. METHODS: Medical history, laboratory data, radiographs, bone scan, and MRI were studied. The bone scan showed lesions in both the axial and peripheral skeletons. As shown on the radiographs and MRI, the C2-C3 vertebral bodies were extensively destroyed. RESULTS: An open biopsy of the right clavicle confirmed the diagnosis of tuberculosis. Because of the neurologic involvement, the patient was treated with C2-C3 anterior radical resection and fusion combined with standard antituberculosis chemotherapy. During a follow-up period of 12 months, no progression in other skeletal lesions was observed. Follow-up radiographs showed fusion in the C2-C3 lesions. CONCLUSIONS: Although the prognosis of Jüngling disease is good, radical surgical treatment should be chosen when there is neurologic involvement. To prevent such a severe type of tuberculosis, it is recommended that steroid therapy should be withheld until tuberculosis is excluded in the diagnosis.
STUDY DESIGN: A case is reported. OBJECTIVES: To report and discuss a case of multiple cystic tuberculous skeletal lesions. SUMMARY OF BACKGROUND DATA: Multiple cystic tuberculosis lesions of the skeleton, or Jüngling disease, is a rare variety of tuberculosis reported extensively 30 to 40 years ago. No such severe type of tuberculosis has been reported in recent years. The patient was a 43-year-old woman with a history of steroid treatment, whose cervical lesions caused C2 and C3 destruction and spinal cord impingement. METHODS: Medical history, laboratory data, radiographs, bone scan, and MRI were studied. The bone scan showed lesions in both the axial and peripheral skeletons. As shown on the radiographs and MRI, the C2-C3 vertebral bodies were extensively destroyed. RESULTS: An open biopsy of the right clavicle confirmed the diagnosis of tuberculosis. Because of the neurologic involvement, the patient was treated with C2-C3 anterior radical resection and fusion combined with standard antituberculosis chemotherapy. During a follow-up period of 12 months, no progression in other skeletal lesions was observed. Follow-up radiographs showed fusion in the C2-C3 lesions. CONCLUSIONS: Although the prognosis of Jüngling disease is good, radical surgical treatment should be chosen when there is neurologic involvement. To prevent such a severe type of tuberculosis, it is recommended that steroid therapy should be withheld until tuberculosis is excluded in the diagnosis.