braz j infect dis.2013;17(1):106–107
The Brazilian Journal of
INFECTIOUS DISEASES
w w w .e l s e v i e r . c o m / l o c a t e / b j i d
Clinical image
Pott abscess mimicking aortic aneurysm in chest X-ray
Yasemin Akkoyunlu
a, Turan Aslan
a, Muhammed Emin Akkoyunlu
b,∗aBezmialemVakifUniversity,SchoolofMedicine,DepartmentofInfectiousDiseasesandClinicalMicrobiology,Istanbul,Turkey
bBezmialemVakifUniversity,SchoolofMedicine,DepartmentofPulmonaryMedicine,Istanbul,Turkey
a r t i c l e i n f o
Articlehistory:
Received20June2012 Accepted24June2012
Availableonline16January2013
Drug resistance in tuberculosisis an exponential problem allaroundtheworld.Spondylodiscitisandosteomyelitisare otherchallengesforspecialiststoovercome.Whentheprob- lemoccursduetomultidrug-resistanttuberculosis(MDR),it appreciablegrows.
A21-year-oldmanpresentedwithslopingcervicalmass.
He was diagnosed with lymphadenitis caused by tubercu- losis and taking antituberculosis drugs for 5 months. He receivedisoniazid,rifampin,ethambutol,andmorfosinamide for2monthsandthencontinuewithisoniazidandrifampin.
Atthe endof second monththe leakagestopped, but one monthlater,leakagefromthelymphadenitisreoccurred.He hadnightsweats,andweightlossthatneverdecreasedwith antibiotherapy.Hepresentedwithseriousbackpainsincelast year.Hehad nohistoryoflungtuberculosis,buthisfamily members presentedwith tuberculosis.His fatherhad lung tuberculosiswhereashismotherandsisterhadtuberculosis lymphadenitis.Allofthemreceivedstandardantituberculo- sistherapyandtheirtherapywassuccessfullycompleted.In ourpatientcomputerizedtomography(CT)scanningofthorax demonstratedaPottabscessformation,nearly15cmlength betweenthoracic vertebrae 5and 11,which may be easily misdiagnosedas an aortic aneurism with the imagination on chest X-ray(Figs. 1 and 2). Microbiological samplewas
∗ Correspondingauthorat:BezmialemVakifUniversity,SchoolofMedicine,DepartmentofPulmonaryMedicine,VatanCad.Fatih34093, Istanbul,Turkey.Tel.:+902124531700.
E-mailaddress:eminakkoyunlu@gmail.com(M.E.Akkoyunlu).
Fig.1–ChestX-rayimaginationshowingthebordersof abscesswhichmimicksaorticaneurism.
1413-8670/$–seefrontmatter©2013ElsevierEditoraLtda.Allrightsreserved.
http://dx.doi.org/10.1016/j.bjid.2012.06.028
brazj infect dis.2013;17(1):106–107
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Fig.2–Computerizedtomography(CT)imaginationof Pott’sabscess.
taken with CT-guided biopsy. Only one acid fast bacilli (AFB) was seen with AFB stain. Mycobacterium tuberculo- sis yielded at Lowenstein–Jensen culture medium. This bacilli was found resistant to all primary antituberculosis therapeutic agents that he was taking. His therapy was stoppedandamikacin1g/day+ethionamide1000mg/day+ cycloserine1000mg/day+ofloxacin400mg/day+prazinamide 2500mg/daywasgiven.
Drugresistancemustbethoughtinpatientswhodonot improvewithstandardantituberculosistherapy.Accordingto ourknowledgethiswasthefirstcaseofvertebralosteomyelitis causedbyMDRtuberculosisinTurkey.
Conflict of interest
Theauthorshavenoconflictofinteresttodeclare.
