A case of spinal tuberculosis with cold abscess presenting with atypical clinical manifestations
非典型临床表现脊柱结核合并冷脓肿1例

摘要

脊柱结核（spinal tuberculosis，STB）是肺或其它部位结核杆菌经血行播散到椎体骨质内引起脊柱骨髓炎症性疾病，它约占骨骼结核病例50%，脊柱结构的破坏会导致脓肿的形成，脓肿可在筋膜和神经血管平面后作为冷脓肿到达远端部位[1]。脊柱结核由于早期临床症状和影像学表现缺乏特异性，难以与不典型脊柱转移瘤、布鲁氏菌病等疾病鉴别，其漏诊、误诊率较高，若未及时治疗，会导致患者病情恶化甚至截瘫[2]。因此，本文报道1例不典型临床表现的脊柱结核合并冷脓肿患者，该患者以腹痛为主诉，无发热、盗汗等典型结核中毒症状，早期易误诊为腹腔疾病，通过探讨其临床特点、影像学表现，从而提高临床医师对脊柱结核的认识，避免漏诊、误诊的发生。

Abstract

Spinal tuberculosis (STB) is an inflammatory disease of the spinal bone marrow caused by Mycobacterium tuberculosis disseminated through the bloodstream to the vertebral bone. It accounts for approximately 50% of bone tuberculosis cases. The destruction of the spinal structure can lead to the formation of abscesses, which can spread as cold abscess along the fascia and neurovascular planes to distant sites [1]. Due to the lack of specificity in early clinical symptoms and imaging manifestations, spinal tuberculosis is difficult to distinguish from atypical spinal metastases, brucellosis, and other diseases, resulting in a high rate of missed and misdiagnosis. If not treated in time, it can lead to deterioration of the patient's condition and even paraplegia [2]. Therefore, this article reports a case of atypical clinical manifestations of spinal tuberculosis complicated with cold abscess. The patient mainly complained of abdominal pain and had no typical tuberculosis toxic symptoms such as fever and night sweats. In the early stage, it was easily misdiagnosed as abdominal cavity disease. By discussing its clinical characteristics and imaging manifestations, it aims to enhance the understanding of spinal tuberculosis among clinicians and avoid the occurrence of missed diagnosis and misdiagnosis.