IL-10 and TGF-ß1 may weaken the efficacy of preoperative anti-tuberculosis therapy in older patients with spinal tuberculosis.

Spinal tuberculosis is a common extrapulmonary type that is often secondary to pulmonary or systemic infections. Mycobacterium tuberculosis infection often leads to the balance of immune control and bacterial persistence. In this study, 64 patients were enrolled and the clinicopathological and immunological characteristics of different age groups were analyzed. Anatomically, spinal tuberculosis in each group mostly occurred in the thoracic and lumbar vertebrae. Imaging before preoperative anti-tuberculosis therapy showed that the proportion of abscesses in the older group was significantly lower than that in the younger and middle-aged groups. However, pathological examination of surgical specimens showed that the proportion of abscesses in the older group was significantly higher than that in the other groups, and there was no difference in the granulomatous inflammation, caseous necrosis, inflammatory necrosis, acute inflammation, exudation, granulation tissue formation, and fibrous tissue hyperplasia. B cell number was significantly lower in the middle-aged and older groups compared to the younger group, while the number of T cells, CD4+ T cells, CD8+ T cells, macrophages, lymphocytes, plasma cells, and NK cells did not differ. Meaningfully, we found that the proportion of IL-10 high expression and TGF-ß1 positive in the older group was significantly higher than that in the younger group. TNF-α, CD66b, IFN-γ, and IL-6 expressions were not different among the three groups. In conclusion, there are some differences in imaging, pathological, and immune features of spinal tuberculosis in different age groups. The high expression of IL-10 and TGF-ß1 in older patients may weaken their anti-tuberculosis immunity and treatment effectiveness.

Bilateral Endoscopic Debridement Combined with Local Antituberculosis Drugs for Thoracic Tuberculosis with Large Paravertebral Abscess: A Multicenter Study with 4-year Follow-Up.

BACKGROUND: Paravertebral abscess represents a prevalent manifestation of thoracic tuberculosis, often necessitating surgical intervention. In this study, we introduced a novel approach by employing bilateral endoscopic debridement (BED) to address large Paravertebral abscesses associated with thoracic tuberculosis, a method not previously proposed in the literature. The clinical efficacy was examined through a comprehensive 4-year follow-up. METHODS: We conducted a retrospective analysis on patients diagnosed with thoracic tuberculosis and paravertebral abscess who underwent BED combined with local antituberculosis drugs (BED + LAD) between February 2015 and February 2019. A total of 29 eligible patients (12 males and 17 females) with a median (interquartile ranges) of 59.0(16.5) years were included in the study. All patients received the BED + LAD treatment. After the surgery, the patients were treated with a 4-drug antituberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol). All relevant indicators were meticulously recorded and analyzed. RESULTS: The surgical procedures were successfully completed for all subjects, with an average intraoperative bleeding volume of (25.2 ± 8.9) ml, an average surgical time of (68.4 ± 14.0) minutes, an average fluoroscopy frequency of (21.7 ± 8.2) times, an average hospital stay of (14.2 ± 4.3) days, and an average medication period of (42.1 ± 9.6) weeks. All subjects completed at least a 4-year follow-up period. At the final follow-up, ESR and CRP levels returned to normal, and there was no significant increase in the Cobb angle (P>0.05). CONCLUSIONS: The application of BED + LAD in the treatment of thoracic tuberculosis and paravertebral abscess proved to be a safe, effective, and feasible approach.

Healing Assessment of Spinal Tuberculosis: A Systematic Review.

OBJECTIVE: Deciding the healing end point in spinal tuberculosis (STB) remains a controversial topic. The current systematic review aims to address the controversy existing in the literature to find a comprehensive method to assess healing in STB. METHODS: A thorough literature search was carried out for studies with the assessment of healing parameters in STB. Data extraction was carried out manually, which included study characteristics and healing criteria evaluated in each study. RESULTS: Qualitative analysis of 8 included studies showed that healing parameters were described in 3 domains: clinical, hematologic, and radiologic response of the patient to antitubercular chemotherapy. Each domain included various individual parameters, with clinical and radiologic assessment criteria being used in most of the studies. Improvement in terms of pain, constitutional symptoms, weight gain, neurology; variation in erythrocyte sedimentation rate and C-reactive protein; and changes in radiography, magnetic resonance imaging, and positron emission tomography/computed tomography were found to be promising predictors in the assessment of healing. CONCLUSIONS: Radiologic response parameters emerged as the maximally used criteria to assess healing in STB. However, in the absence of any statistical analysis and an observed lag in radiologic response, the cumulative effect of all the parameters in 3 domains (clinical, hematologic, and radiologic) can be used to declare a spinal tubercular lesion nonhealing, healing, or healed.

Differential distribution of linezolid in diseased and nondiseased bones in patients with spinal tuberculosis.

BACKGROUND: Linezolid exhibits antibacterial activity against sensitive and drug-resistant strains of Mycobacterium tuberculosis. Knowledge on the distribution of linezolid in different types of bones in patients with spinal tuberculosis (TB) is lacking, which limits the pharmacokinetic and pharmacodynamic studies of linezolid. This study aimed to evaluate the distribution of linezolid in diseased and nondiseased bones in patients with spinal TB. METHODS: Spinal TB patients treated with linezolid-containing regimens and whose diseased and nondiseased bones were collected during surgery were enrolled retrospectively from January 2017 to February 2022. Blood, nondiseased bones, and diseased bones were collected simultaneously during the operation. Linezolid concentrations in the plasma, nondiseased bones, and diseased bones were subjected to high-performance liquid chromatography-tandem mass spectrometry. RESULTS: Seven eligible spinal TB patients, including one rifampicin-resistant case, were enrolled. Following a 600 mg oral administration of linezolid before surgery, the median concentrations of linezolid in plasma, nondiseased bone, and diseased bone of the seven patients were 8.23, 1.01, and 2.13 mg/L, respectively. The mean ratios of linezolid concentration in nondiseased bones/plasma, diseased bones/plasma and diseased bones/nondiseased bones reached 0.26, 0.49, and 2.27, respectively. The diseased bones/plasma presented a higher mean ratio of linezolid concentration than nondiseased bones/plasma, and the difference was statistically significant (t = 2.55, p = 0.025). Pearson's correlation analysis showed the positively correlation of linezolid concentrations in diseased and nondiseased bones (r = 0.810, p = 0.027). CONCLUSIONS: Linezolid exhibits a higher concentration distribution in diseased bones than in nondiseased bones.

Randomized controlled trial of vitamin d supplementation on toll-like receptor-2 (tlr-2) and toll-like receptor-4 (tlr-4) in tuberculosis spondylitis patients.

BACKGROUND: Tuberculosis spondylitis accounts for approximately 50% of all cases of skeletal tuberculosis. Vitamin D plays a role in the immune system. Vitamin D helps in the activation of TLR-2 and TLR-4, which play a role in the process of tuberculosis infection. The objective of this study was to investigate the effect of oral supplementation with vitamin D on TLR-2 and TLR-4 levels in tuberculosis spondylitis patients. METHODS: The true Experiment Design Pretest-Posttest with Control Group (Pretest-Posttest with Control Group) was used for this research. TLR-2 and TLR-4 were measured by ELISA. Repeated ANOVA, ANOVA tests, and Kolmogorov-Smirnov normality tests on the SPSS program were used to statistically analyze the results. RESULT: In the dose groups of 10,000 IU and 5000 IU, significant increases in the levels of vitamin D, TLR-2, and TLR-4 were observed at weeks 4 and 8 (p < 0.05). In the control group, there was no significant increase. CONCLUSIONS: Vitamin D supplements can significantly increase TLR-2 and TLR-4 levels. Supplementation with vitamin D 10,000 IU/day for 8 weeks can increase vitamin D levels > 50 ng/dl to optimally act as an immunomodulator.

Reporte de caso de enfermedad de Pott en vértebras torácicas altas en un niño de dos años / Pott's Disease in Upper Thoracic Vertebrae in a Two-Year-Old Boy: Case Report

RESUMEN La enfermedad de Pott es un problema de salud en países en desarrollo y su diagnóstico en niños es un desafío. Presentamos el caso de un niño de dos años de edad, con enfermedad de Pott que compromete vértebras torácicas de T1 a T3. El cuadro clínico se caracterizó por dificultad para caminar, fiebre, tos y disnea. Al examen físico, se evidenció cifosis y prominencia ósea en la región cervicodorsal. Se obtuvo una prueba de tuberculina positiva y se aisló Mycobacterium tuberculosis en el cultivo del aspirado gástrico. La resonancia de columna vertebral mostró un absceso frio, destrucción de dos vértebras y compresión de la médula espinal. El paciente presentó mejoría con la terapia antituberculosa. Resaltamos la importancia de tener en cuenta la sospecha clínica para la detección temprana de esta condición, así como un inicio rápido del tratamiento antituberculoso, para evitar la discapacidad y mortalidad asociada a esta enfermedad.

ABSTRACT Pott's disease is a health problem in developing countries and its diagnosis in children is a challenge. Here we present the case of a two-year-old boy with Pott's disease involving T1 to T3 thoracic vertebrae. The clinical presentation was characterized by difficulty walking, fever, cough, and dyspnea. At physical examination, kyphosis and bony prominence were observed in the cervicodorsal area. A positive tuberculin test was obtained, and Mycobacterium tuberculosis was isolated via culture of the gastric aspiration sample. The spine MRI showed a chronic abscess, destruction of two vertebrae, and bone marrow compression. The patient experienced some improvement with anti-TB therapy. Here, we emphasize the importance of giving consideration to the clinical suspicion for the early detection of this condition, as well as a quick TB-treatment start so as to avoid the disability and mortality associated to this disease.

Mal de Pott en paciente con insuficiencia hepática: presentación de un caso de probable tuberculosis espinal y revisión de literatura / Pott's disease on a patient with hepatic insufficiency: case presentation of probable spinal tuberculosis and literature review

Introducción: La Tuberculosis Espinal corresponde a una infección causada por Mycobacteriun tuberculosis localizada en la región vertebral. El tratamiento farmacológico de esta patología no está exento de complicaciones, principalmente dado por la toxicidad hepática. El caso clínico a presentar se centra en el tratamiento farmacológico en un paciente con Insuficiencia Hepática. Presentación del caso: Paciente de 58 años con antecedentes de Insuficiencia Hepática, inició cuadro de 3 meses de evolución caracterizado por dolor lumbar progresivo con escasa a nula respuesta a tratamiento analgésico. Al examen físico destacó dolor axial de columna lumbar, paresia M4 en L5, Lasegue y Tepe (-). Se solicitaron exámenes de imagenología y laboratorio, confirmándose probable diagnóstico de Tuberculosis Espinal. Se inició tratamiento antituberculoso alternativo. Discusión: El tratamiento universalmente aceptado es la asociación de Isoniazida, Rifampicina, Pirazinamida, Etambutol. En relación al caso clínico y a la Insuficiencia Hepática se recomienda no utilizar Pirazinamida y ante riesgo alto reemplazar el uso de Isoniazida por Fluoroquinolona. Además se recomienda medir enzimas hepáticas al inicio del tratamiento y durante su mantención. En caso de encontrarse elevadas, se recomienda iniciar un esquema con mínimo riesgo de toxicidad hepática, asociando Estreptomicina - Etambutol, mientras se normalizan las alteraciones. En el caso clínico presentado el esquema antibiótico considera la asociación de Estreptomicina, Etambutol y Fluoroquinolona. Es importante reconocer la clínica de la Tuberculosis Espinal, con el fin de proporcionar un tratamiento oportuno y eficaz, considerando el riesgo de hepatoxicidad de éste y su indicación en pacientes con diagnóstico de Insuficiencia Hepática.

Introduction: Spinal Tuberculosis corresponds to an infection caused by Mycobacterium tuberculosis located in the vertebral region. The pharmacological treatment of this pathology is not free of complications, mainly due to liver toxicity. The clinical case to be presented focuses on the pharmacological treatment in a patient with Hepatic Insufficiency. Case report: A 58-year-old patient with a history of Hepatic Insufficiency, started a 3-month evolution characterized by progressive lumbar pain with little to no response to analgesic treatment. Physical examination revealed lumbar spine axial pain, M4 paresis in L5, Lasegue and Tepe (-). Imaging and laboratory tests were requested, confirming the probable diagnosis of Spinal Tuberculosis. Alternative antituberculous treatment was started. Discussion: The universally accepted treatment is the association of Isoniazide, Rifampin, Pyrazinamide, Ethambutol. In relation to the clinical case and Hepatic Insufficiency, it is recommended not to use Pyrazinamide and at high risk to replace the use of Isoniazide with Fluoroquinolone. It is also recommended to measure liver enzymes at the start of treatment and during maintenance. In case of being elevated, it is recommended initiate a scheme with minimal risk of liver toxicity, associating Streptomycin - Ethambutol, while the alterations are normalized. In the clinical case presented, the antibiotic scheme considers the association of Streptomycin, Etambutol and Fluoroquinolone. It is important to recognize the clinic of Spinal Tuberculosis, in order to provide timely and effective treatment, considering the risk of hepatoxicity thereof and its indication in patients diagnosed with Hepatic Insufficiency

Absceso del psoas como presentación de tuberculosis vertebral: reporte de un caso / Psoas abscess as spinal tuberculosis presentation: case report

Introducción: El absceso del psoas es un cuadro infrecuente cuyo principal agente etiológico es el Staphyloccocus aureus, y que con baja frecuencia puede ser de etiología tuberculosa como complicación de una afección vertebral por Mycobacterium tuberculosis. Presentación del caso: Mujer de 58 años, mapuche, con antecedentes de enfermedad pulmonar obstructiva crónica y alcoholismo crónico, consultó por cuadro de dos meses de evolución de dolor lumbar, baja de peso y paresia de extremidad inferior derecha que impedía la marcha. Tomografía computada (TC) de columna evidenció espondilodiscitis y absceso del psoas derecho, iniciándose tratamiento antibiótico cubriendo Staphyloccocus aureus. Los hemocultivos y los cultivos de la colección resultaron negativos por lo que se decidió mantener tratamiento ambulatorio. Paciente consultó cuatro meses después por exacerbación de su disnea basal de dos semanas de evolución, radiografía de tórax y TC de tórax de alta resolución compatibles con tuberculosis pulmonar con diseminación miliar bilateral, por lo cual, se inició tratamiento antituberculoso, realizándose baciloscopías que resultaron negativas. Además, se solicitó identificación del bacilo de Koch mediante reacción de polimerasa en cadena que resultó positiva, con lo que se confirmó el diagnóstico de tuberculosis miliar y mal de Pott. Se decidió reevaluar con TC de columna una vez finalizado el tratamiento antituberculoso para decidir conducta quirúrgica. Discusión: Es importante la sospecha activa de etiología tuberculosa ante una espondilodiscitis y un absceso del psoas, pese a su baja frecuencia. El inicio del tratamiento en forma precoz puede modificar la progresión de una infección que puede ser invalidante e incluso mortal.

Introduction: The Psoas abscess is an infrecuent condition which main ethiology is the Staphyloccocus aureus and with less frequency can be a vertebral tuberculosis complication caused by Mycobacterium tuberculosis. Case Report: a 58 years old female, Mapuche, with Chronic Obstructive Pulmonar Disease and chronic alcoholism antecedents, was admitted in the emergency room with a two month old lumbar pain, loss of weight and right inferior extremity paresia which didn't allowed her to walk. The column's Computed Tomography (CT) showed spondylodiscitis and a right psoas abscess, the antibiotherapy, covering Staphyloccocus aureus, was started. The hemoculives and abscess' cultives were negative, so it was decided to continue with ambulatory treatment. The patient was admitted four month later because of two weeks of exacerbation of her basal dysnea. The thorax Radiography and high resolution CT were compatibles with pulmonary tuberculosis with bilateral miliar disemination. Antituberculosis treatment was started, bacilloscopies were negative, also, a Polymerase Chain Reaction identification of Koch's bacillus was performed, resulting positive, confirming the diagnosis of miliar tuberculosis and Pott's disease. Once antituberculosis treatment was finished, a new column's CT was requested to decided surgical conduct. Discussion: Is important to actively suspect of tuberculosis ethiology in presence of spondylodiscitis and psoas abscess, despite it's low frequency. The early treatment start may modify the progresion of an infección that can be invalidating and even mortal.

Mal de Pott en un indígena colombiano / Pott´s disease in a Colombian indigenous man

Cada año mueren alrededor de dos millones de personas a causa de la tuberculosis y se estima que un tercio de la población mundial está infectada con el bacilo que la causa, pero solo entre 5 y 10 % desarrolla la enfermedad. El riesgo de que la enfermedad progrese al estado activo depende de factores endógenos y exógenos. Las comunidades indígenas son un grupo con un alto riesgo de infectarse y enfermar de tuberculosis; además de factores como el aislamiento geográfico, el abandono social y cultural y la desnutrición, se han identificado en ellos polimorfismos genéticos que los hacen más propensos a la infección. La tuberculosis vertebral es la forma más destructiva de la enfermedad y representa cerca de la mitad de los casos de tuberculosis esquelética. Se presenta el caso de un paciente indígena colombiano con tuberculosis vertebral y resultado negativo para HIV. El diagnóstico se basó en los hallazgos clínicos y en los estudios de imaginología, y se confirmó mediante la prueba molecular rápida Genotype MTBDR plus ® y de la reacción en cadena de la polimerasa PCR IS6110; el cultivo fue negativo a las 16 semanas de incubación. Se discuten brevemente la patogénesis, el diagnóstico y el tratamiento, y se comentan algunos aspectos relacionados con la situación de la tuberculosis en las comunidades indígenas colombianas.

Approximately 2 million people die each year from tuberculosis. One third of the world´s population is estimated to be infected with the tuberculosis bacillus, although only 5-10% will develop the disease in their lifetime. The disease progression risk depends on endogenous and exogenous factors. Indigenous communities are a high-risk group for infection and development of tuberculosis. In addition to factors such as geographical isolation, social and cultural neglect and malnutrition, susceptibility to genetic polymorphisms has been identified in them. Spinal tuberculosis is the most destructive form of the disease, which represents approximately half of all cases of skeletal tuberculosis. The case of an HIV negative, indigenous Colombian man is presented. His diagnosis was done based on clinical and image findings, and it was confirmed with the rapid molecular assay Genotype MTBDRplus ® and IS6110 PCR.The culture in solid media was negative after 16 weeks. We briefly discuss the pathogenesis, diagnosis and treatment. Finally, we comment on some aspects of the situation of tuberculosis among indigenous Colombian communities.

Absceso del psoas tuberculoso, debut en paciente inmunodeprimido: presentación de un caso / Tuberculous psoas abscess, debut in immunocompromised patient: case report

INTRODUCCIÓN: El absceso del psoas (AP) es una patología infrecuente de difícil diagnóstico. Se clasifica en primario o secundario teniendo como factor de riesgo común la inmunodeficiencia. PRESENTACIÓN DEL CASO: Paciente masculino de 40 años sin antecedentes mórbidos. Consulta por cuadro de un mes de evolución caracterizado por dolor lumbar derecho que aumenta al flexionar el muslo ipsilateral. Se asocia compromiso del estado general, dolor abdominal, sensación febril no cuantificada y bradipsiquia. La Tomografía computada (TC) de abdomen y pelvis mostró hipodensidad en relación al músculo psoas derecho diagnosticándose AP primario. El paciente evoluciona con shock séptico, siendo manejado con antibióticos de amplio espectro sin mejoría. Se realizan exámenes generales, Punción lumbar (PL) y Test de Elisa para VIH (TEVIH), resultando la PL compatible con Tuberculosis meníngea y el TE positivo. Se inició tratamiento empírico anti-tísico en espera del cultivo de Koch. Paciente evoluciona favorablemente. Se realiza una TC de control luego de dos semanas de tratamiento, que muestra imagen similar a la inicial, agregándose compromiso vertebral L4-L5, diagnosticándose Enfermedad de Pott (EP) y AP secundario. Se realiza punción y drenaje del absceso y se toma cultivo de Koch que resulta positivo. Paciente evoluciona asintomático, con buena respuesta al tratamiento. DISCUSIÓN: El AP secundario a EP es una entidad poco sospechada. Sin embargo, con métodos diagnósticos como la TC es posible realizar un diagnóstico precoz. Mycobacterium tuberculosis es una causa infrecuente de abscesos del psoas, pero debido al aumento de la población VIH positiva, es probable que aumente su incidencia.

INTRODUCTION: Psoas abscess is an uncommon disease with difficult diagnosis. It can be primary or secondary; immunodeficiency is among risk factors. CASE REPORT: 40 year-old male with no past medical history. He presented to the emergency department with right lumbar pain worsened with flexion of ipsilateral thigh. Involvement of general condition, abdominal pain, unquantified fever and bradypsychia were also present. Computed tomography (CT) scan of the abdomen and pelvis showed an hypodense lesion in the right psoas muscle. Primary psoas abscess was first diagnostic impression. Patient evolved to septic shock and was treated with broad spectrum antibiotics without improvement. General examinations were performed, lumbar puncture supported meningeal tuberculosis and HIV ELISA test was positive. Empirical quintuple therapy for tuberculosis was started before cerebrospinal fluid culture results, with favorable clinical evolution. Control CT scan was similar compared to first one but with L4 – L5 vertebrae involvement. Pott disease and secondary psoas abscess was diagnosed. Koch’s Bacillus culture from abscess puncture were positive. Patient had clinical improvement with antituberculous therapy. DISCUSSION: Psoas abscess is a rarely suspected patology, but with diagnostic methods as CT is possible to make an early diagnosis. Even though Mycobacterium tuberculosis is a rarer cause of psoas abscess, but more cases are expected due to the increased incidence of HIV – positive patients, more cases are expected eventually.

Espondilodiscitis tuberculosa en Cádiz (España) durante diez años / Tuberculous spondylodiscitis. Report of six patients

Background: Tuberculous spondylodiscitis is relatively uncommon but represents the most common location of osseous tuberculosis. Aim: To describe clinical features, imaging studies and laboratory tests to establish the diagnosis in a group of patients living in Cádiz (Spain). Material and Methods: Retrospective analysis of medical records of patients with tuberculous spondylodiscitis diagnosed between 2000 and 2009. The diagnosis was based on microorganism recovery from vertebral samples obtained by imaging guided biopsies. Results: Six patients with positive Mycobac-terium tuberculosis cultures from vertebral samples, were identified (10 percent of extra-pulmonary tuberculosis). In only 2 patients the Ziehl-Nielsen stain was positive, and histology was compatible in 4 cases. Four patients were females, their mean age was 54.3 years and the mean duration of symptoms was 7.3 months. Three patients had lumbar location and a positive Mantoux test. A soft tissue abscess was present in 4 cases. None of these patients had neurological complications. The treatment with four tuberculostatic agents (isoniazid, rifampicin, pyrazinamide and ethambutol) was effective in 5 patients. Conclusions: Tuberculous spondylodiscitis may become a serious disease due to diagnostic and treatment delays. The main examinations to establish diagnosis are magnetic resonance imaging and biopsy with microbiological culture. Generally, antituberculous therapy is effective in this clinical situation.

PCR identification of Mycobacterium tuberculosis complex in a clinical sample from a patient with symptoms of tuberculous spondylodiscitis

A 42-year-old male complaining of thoracic spine pain was admitted to the hospital for evaluation. An X-ray and computer tomography of the thoracic spine showed spondylodiscitis of the L3 lumbar and L2-L3 intervertebral disk. The tuberculin skin test (PPD) was strongly positive. A radioscopy-guided fine needle aspirate of the affected area was cultured but did not reveal the cause of the disease. Two biopsy attempts failed to reveal the cause of the disease by culturing or by acid-fast-resistant staining (Ziehl Neelsen) of the specimens. A third biopsy also failed to detect the infectious agent by using microbiological procedures, but revealed the presence of a 245-bp amplicon characteristic of the Mycobacterium tuberculosis complex after PCR of the sample. The result demonstrates the efficacy of PCR for the identification of M. tuberculosis in situations in which conventional diagnosis by culturing techniques or direct microscopy is unable to detect the microorganism. Following this result the patient was treated with the antituberculous cocktail composed by rifampicin, pirazinamide and isoniazid during a six-month period. At the end of the treatment the dorsalgia symptoms had disappeared.

Tuberculose de coluna cervical baixa em crianca: relato de caso / Tuberculosis of the lower cervical spine in a child: a case report

Os autores apresentam um caso de crianca de oito anos com queixa de dor e deformidade em regiao cervical com duracao de tres meses, alem de sinais de compressao medular...

Mal de Pott: diagnóstico y tratamiento / Bad of Pott: I diagnose and treatment

Reportamos 2 casos de espondilitis tuberculosa en mujeres de 51 a 65 años de edad respectivamente quienes presentaron dolor en la columna vertebral acompañado de síntomas generales, una de ellas con compromiso neurológico. Ambas tuvieron lesiones osteolíticas, y espondilodiscitis en la resonancia magnética. En el segundo caso, además hubo evidencia de abscesos fríos en cuerpos vertebrales y músculos paravertebrales que requirió debridación y descomprensión medular más artrodesis de columna. Recibieron tratamiento con agentes antituberculosos con buena evolución.