Tuberculosis of sacrum.

Dear Editor,

The recent report by Sament et al. [1] on tuberculosis of sacrum is very interesting. We here present a case with monoparesis. The case of tuberculosis of sacrum is uncommon and can be delay-diagnosed. Kumar et al. [2] noted that this disorder has to be included in differential diagnosis of patients presenting with sacral mass lesion in tropical countries. The condition can present severe low back pain, and may have radiating pain and neurological alteration in lower extremities [3]. The management of the condition is usually by antituberculotic drug and surgical decompression [3]. The difficulties are often in the diagnostic phase. Since the radiological manifestation of tuberculosis diskitis/osteomyelitis is often similar to pyogenic diskitis/osteomyelitis, although it can be differentiated from malignancy, it is extremely difficult to make a clear diagnosis [4]. The open biopsy can be useful, which may be done for decompression to relieve patient's clinical symptoms. The present case has the interesting concern of monoparesis. Spinal stenosis due to spinal tuberculosis can present this clinical feature. The compression of the cord can be in any direction, and it may be more probable in cases of sacral lesion, since the sacral spine has a wider area compared to other parts of the spine.