RESUMO
Iliopsoas abscess is an infrequent condition characterized by the collection of pus in the iliopsoas compartment. The prevalence of the disease has been increasing in recent years with the emergence of various comorbidities and risk factors. The availability of newer imaging modalities has also improved the detection of new cases. Salmonellosis is an uncommon etiology in iliopsoas abscess and sacroiliitis. Most cases reported in the literature are associated with Staphylococcus aureus, Streptococci species, and Escherichia coli. Diabetes, hematological malignancies, HIV, and other immunocompromised states are important comorbidities/risk factors for iliopsoas abscess. We report a case of an 18-year-old male who presented with a history of fever and right hip pain for 10 days. Radioimaging revealed right sacroiliitis and iliopsoas abscess. Blood culture revealed pan-sensitive Salmonella typhi. After the prolonged course of antibiotics (intravenous ceftriaxone followed by oral levofloxacin), the patient improved with no further relapse in symptoms. Salmonella typhi should be an important differential of iliopsoas abscess in endemic regions after ruling out the common etiology such as S. aureus and Mycobacterium tuberculosis.
Assuntos
Antibacterianos , Ceftriaxona , Abscesso do Psoas , Sacroileíte , Salmonella typhi , Humanos , Masculino , Abscesso do Psoas/microbiologia , Abscesso do Psoas/tratamento farmacológico , Abscesso do Psoas/diagnóstico por imagem , Adolescente , Sacroileíte/microbiologia , Sacroileíte/tratamento farmacológico , Sacroileíte/diagnóstico por imagem , Salmonella typhi/isolamento & purificação , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Febre Tifoide/tratamento farmacológico , Febre Tifoide/complicações , Febre Tifoide/diagnóstico , Febre Tifoide/microbiologia , Levofloxacino/uso terapêutico , ImunocompetênciaRESUMO
Here, we report a case of malignant psoas syndrome presented to us during the second peak of the COVID-19 pandemic. Our patient had a medical history of hypertension, recently diagnosed with left iliac deep vein thrombosis and previous breast and endometrial cancers. She presented with exquisite pain and a fixed flexion deformity of the left hip. A rim-enhancing lesion was seen within the left psoas muscle and was initially deemed to be a psoas abscess. This failed to respond to medical management and attempts at drainage. Subsequent further imaging revealed the mass was of a malignant nature; histology revealing a probable carcinomatous origin. Following diagnosis, palliative input was obtained and, unfortunately, our patient passed away in a hospice shortly after discharge. We discuss the aetiology, radiological findings and potential treatments of this condition and learning points to prompt clinicians to consider this diagnosis in those with a personal history of cancer.
Assuntos
COVID-19 , Neoplasias , Abscesso do Psoas , Feminino , Humanos , Pandemias , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/etiologia , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/patologiaRESUMO
Infectious aortitis has various causes, presents mainly with an aneurysm, and is fatal without surgical intervention. This case report describes an 89-year-old woman who developed fever and back pain which initially diagnosed infectious aortitis confirmed through contrast-enhanced computed tomography (CT). Pyogenic spondylitis and psoas abscess, which were not visible through CT at admis-sion, were identified as the cause of infectious aortitis confirmed through positron emission tomography (PET). After percutaneous drainage and intravenous antibiotics, the patient was discharged in good condition and without surgical intervention. This case report emphasizes the critical role of PET in identifying the cause of infectious aortitis and demonstrates the effectiveness of successive treat-ment with antibiotics and timely radiologic intervention.
Assuntos
Aortite , Abscesso do Psoas , Espondilite , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Aortite/diagnóstico por imagem , Aortite/tratamento farmacológico , Feminino , Humanos , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/terapia , Espondilite/diagnóstico por imagem , Espondilite/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodosRESUMO
La sacroileítis infecciosa (SII), también descrita en la literatura como sacroileítis séptica o piógena, es una patología infrecuente, y su diagnóstico constituye un reto debido a su rareza relativa y la diversa presentación clínica, que frecuentemente imita otros trastornos más prevalentes originados en estructuras vecinas. Se requiere un alto índice de sospecha y un examen físico acucioso para un diagnóstico oportuno, mientras que los estudios de laboratorio y de imagen ayudan a confirmar el diagnóstico y dirigir la estrategia de tratamiento apropiada para evitar complicaciones y secuelas a corto y mediano plazos. Presentamos un caso de paciente de género femenino de 36 años, con cuadro clínico de SII izquierda, secundaria a un absceso del músculo iliopsoas, condición que generalmente se presenta como una complicación de la infección. Se realizaron los diagnósticos clínico, imagenológico y Biológico, se inició el tratamiento antibiótico oportuno, y se logró una excelente evolución clínica, sin secuelas
Infectious sacroiliitis (ISI), also described in the literature as septic or pyogenic sacroiliitis, is an infrequent pathology, and its diagnosis constitutes a challenge due to its relative rarity and the diverse clinical presentation, frequently imitating other more prevalent disorders originating in neighboring structures. A high index of suspicion and a thorough physical examination are required in order to establish an opportune diagnosis, while laboratory and imaging studies help confirm the diagnosis and direct the appropriate treatment strategy to avoid complications and sequelae in the short and medium terms. We herein present a case of a female patient aged 36 years, with a clinical picture of left ISI, secondary to an iliopsoas muscle abscess, a condition that usually presents as a complication of the infection. The clinical, imaging and microbiological diagnoses were made, the timely antibiotic treatment was initiated, and an excellent clinical evolution without sequelae was achieved.
Assuntos
Humanos , Feminino , Adulto , Abscesso do Psoas/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Staphylococcus aureus/isolamento & purificação , Imageamento por Ressonância Magnética/métodos , Tomografia por Raios X/métodosRESUMO
PURPOSE: While endovascular repair of aortic aneurysm (EVAR) has become the mainstay treatment for abdominal aortic aneurysm (AAA), it is not without its disadvantages. Feared complications include graft infections, fistulation and endoleak, the outcomes of which may be life limiting. CASE REPORT: We present a case of a 57 year-old patient with human immunodeficiency virus (HIV) previously treated with EVAR for AAA complicated by endoleak post treatment. He developed an aorto-psoas abscess 2 years later which harboured Mycobacterium avium complex, and medical therapy was unsuccessful. He eventually underwent an extra-anatomical bypass and graft explant, for which an aortoenteric fistula was also discovered and repaired. CONCLUSION: Infection of endografts post EVAR is relatively rare, and there are presently no guidelines concerning its management. The concomittance of aorto-psoas abscess and aortoenteric fistula is even more uncommon, and necessitated surgical explant for source control purposes in our patient. Lifelong surveillance is required for complications of the aortic stump and bypass patency.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Hospedeiro Imunocomprometido , Fístula Intestinal/etiologia , Infecções Relacionadas à Prótese/etiologia , Abscesso do Psoas/etiologia , Fístula Vascular/etiologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Endoleak/diagnóstico por imagem , Endoleak/cirurgia , Procedimentos Endovasculares/instrumentação , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/cirurgia , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgiaRESUMO
Pott's disease may accompany psoas abscesses, but bilateral psoas abscess is rarely encountered. Computerised Tomography (CT) is the gold standard for the diagnosis of psoas abscesses. Treatment of psoas abscess usually involves drainage of abscess and antibiotic therapy. CT and USG-guided catheters are often utilised for abscess drainage. In cases where neurological symptoms are observed, open surgery may be required. Pott's disease accompanied by bilateral psoas abscess was detected in a 21-year-old male patient who was admitted to the clinic with complaints of low back pain and weakness in his left leg at the Selcuk University, Turkey, in 2018. The reason for the development of neurological deficit only on the left side was the compression of the nerve roots by the abscess tissue. The patient underwent debridement and anterior instrumentation with an anterior approach. In the postoperative follow-up it was observed that the patient's complaints were relieved. Pott's disease with bilateral psoas abscesses, in which debridement and instrumentation with an anterior approach is applied, has not been previously reported in the literature, and the current case is a first in this respect.
Assuntos
Abscesso do Psoas , Tuberculose da Coluna Vertebral , Masculino , Humanos , Adulto Jovem , Adulto , Abscesso do Psoas/diagnóstico , Abscesso do Psoas/diagnóstico por imagem , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Drenagem/métodos , Tomografia Computadorizada por Raios X , Antibacterianos/uso terapêuticoRESUMO
Iliopsoas abscesses (IPA) are uncommon, with an associated mortality rate of up to 20%. We describe the case of a 55-year-old man war veteran who presented with an unusual cause of IPA secondary to retained foreign body (FB). His initial trauma 30 years before was a result of a blast injury with shrapnel penetration suffered after inadvertently driving over a landmine as an ambulance driver in a conflict region. A CT scan was performed, revealing a 13 mmx8 mm radio-opaque FB within the right psoas at the level of the fifth lumbar vertebra with a surrounding collection. Subsequent open surgical exploration removed two gravel fragments. Given the knowledge of a traumatic blast injury with retained FB and repeated episodes of sepsis, surgical exploration is warranted. To our knowledge, this is the first case of recurrent IPA secondary to a retained FB from a historical trauma.
Assuntos
Traumatismos por Explosões , Corpos Estranhos , Abscesso do Psoas , Traumatismos por Explosões/complicações , Traumatismos por Explosões/diagnóstico por imagem , Traumatismos por Explosões/cirurgia , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/etiologia , Abscesso do Psoas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
A 52-year-old woman was referred to our department with multiple discharging sinuses and swelling in the right flank and iliac region for the past year. Ultrasound revealed a large collection in the right psoas muscle with the sinus tract reaching up to the skin in the right iliac region. Despite repeated attempts at drainage, the collection continued to increase in size. CT was requested and revealed a large heterogeneous irregular collection in the right psoas with fistulous communication with the cecum and skin with the erosion of the overlying ilium. Because of lack of vertebral involvement, enhancing internal septations, non-visualisation of the appendix and feculent material admixed with mucinous discharge from the sinus, pseudomyxoma retroperitonei secondary to ruptured mucinous neoplasm of the appendix was suspected. Mucoid material at the local site was sent for histopathology, which confirmed our suspicion. Our treatment plan after ileostomy was cytoreductive surgery along with adjuvant radiotherapy (40 Gy in 20 fractions) with chemotherapy (5-fluorouracil and folinic acid given for 30 weeks, once a week). However, after ileostomy, the patient refused further treatment, citing financial reasons.
Assuntos
Apêndice , Pseudomixoma Peritoneal , Abscesso do Psoas , Feminino , Fluoruracila , Humanos , Leucovorina , Pessoa de Meia-Idade , Pseudomixoma Peritoneal/diagnóstico , Abscesso do Psoas/diagnóstico por imagem , UltrassonografiaRESUMO
Vertebral osteomyelitis is an infection of the vertebrae that can lead to spinal degeneration, most commonly caused by Staphylococcus aureus Here, we report an unusual case of pyogenic osteomyelitis caused by Gardnerella vaginalis and Streptococcus parasanguinis in a 61-year-old postmenopausal woman. The patient presented with a 2-week history of worsening lower back pain and fever and a recent episode of cystitis following re-engagement of sexual activity. Imaging revealed a deterioration of vertebrae discs and spinal canal stenosis at the L3-L4 levels with a formation of abscess in the right psoas muscle. Needle aspiration of the abscess identified G. vaginalis and S. parasanguinis and the patient was successfully treated with a 6-week course of ceftriaxone and metronidazole. This case describes an unusual coinfection of two pathogens that normally reside in the urogenital tract and oral cavity, respectively, and highlights the risk posed when these organisms breach the body's normal barriers.
Assuntos
Discite/microbiologia , Gardnerella vaginalis/isolamento & purificação , Vértebras Lombares , Osteomielite/microbiologia , Abscesso do Psoas/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Antibacterianos/uso terapêutico , Técnicas de Cultura , Discite/diagnóstico por imagem , Discite/tratamento farmacológico , Discite/fisiopatologia , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Osteomielite/fisiopatologia , Pós-Menopausa , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/tratamento farmacológico , Estenose Espinal/fisiopatologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológicoRESUMO
OBJECTIVE. The purpose of this article is to review the spectrum, etiopathogenesis, clinical presentation, imaging features, differential diagnoses, and management of emphysematous infections of the abdomen and pelvis. CONCLUSION. Emphysematous infections are associated with high morbidity and mortality and thus need urgent medical and surgical interventions. CT is the most sensitive modality to detect gas; CT provides definitive diagnosis in most cases and can depict the extent of involvement.
Assuntos
Enfisema/diagnóstico por imagem , Gases , Tomografia Computadorizada por Raios X , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/microbiologia , Abscesso/diagnóstico por imagem , Abscesso/microbiologia , Aortite/diagnóstico por imagem , Aortite/microbiologia , Cistite/diagnóstico por imagem , Cistite/microbiologia , Enfisema/microbiologia , Colecistite Enfisematosa/diagnóstico por imagem , Colecistite Enfisematosa/microbiologia , Feminino , Gangrena de Fournier/diagnóstico por imagem , Gangrena de Fournier/microbiologia , Gangrena Gasosa/diagnóstico por imagem , Gangrena Gasosa/microbiologia , Gastrite/diagnóstico por imagem , Gastrite/microbiologia , Hepatite/diagnóstico por imagem , Hepatite/microbiologia , Humanos , Masculino , Pancreatite/diagnóstico por imagem , Pancreatite/microbiologia , Doenças Prostáticas/diagnóstico por imagem , Doenças Prostáticas/microbiologia , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/microbiologia , Pielite/diagnóstico por imagem , Pielite/microbiologia , Pielonefrite/diagnóstico por imagem , Pielonefrite/microbiologia , Doenças Uterinas/diagnóstico por imagem , Doenças Uterinas/microbiologiaRESUMO
Aortoenteric fistula after endovascular aortic repair for an abdominal aortic aneurysm is a rare but severe complication. Particularly, a case of inflammatory abdominal aortic aneurysm is extremely rare and there are only 3 reported cases. A 70-year-old man underwent endovascular aortic repair for impending rupture of an inflammatory abdominal aortic aneurysm and was medicated steroids for approximately 2 years. Four years after endovascular aortic repair, he developed endograft infection with an aortoduodenal fistula and a left psoas abscess. He underwent total endograft excision, debridement, in situ reconstruction of the aorta using prosthetic grafts with omental coverage, and digestive tract reconstruction to prevent leakage. Pseudomonas aeruginosa was detected in the infected aortic sac. The patient has not experienced recurrence of infection in the 35 months since his operation.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Duodenopatias/microbiologia , Procedimentos Endovasculares/efeitos adversos , Fístula Intestinal/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções por Pseudomonas/microbiologia , Abscesso do Psoas/microbiologia , Fístula Vascular/microbiologia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Desbridamento , Remoção de Dispositivo , Duodenopatias/diagnóstico por imagem , Duodenopatias/cirurgia , Procedimentos Endovasculares/instrumentação , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Masculino , Omento/cirurgia , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia , Infecções por Pseudomonas/diagnóstico por imagem , Infecções por Pseudomonas/cirurgia , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/cirurgia , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgiaAssuntos
Cálculos/terapia , Drenagem , Nefrotomia , Abscesso do Psoas/terapia , Pielonefrite Xantogranulomatosa/complicações , Cálculos/diagnóstico por imagem , Cálculos/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/etiologia , Pielonefrite Xantogranulomatosa/diagnóstico por imagem , Radiografia Intervencionista , Resultado do TratamentoRESUMO
Extrapulmonary tuberculosis (TB) is rare in immunocompetent healthy adults. TB of the chest wall accounts for 1%-5% of all cases of musculoskeletal TB. Psoas abscess can be either primary or secondary to diseases like Pott's spine. We describe a patient with massive lower chest wall abscess extending to abdominal muscles and an asymptomatic large psoas abscess detected on imaging due to spine TB which responded well to antitubercular therapy and drainage without surgical measures. The concomitant presence of a massive chest wall abscess and psoas abscess due to TB in an immunocompetent patient was not reported previously.
Assuntos
Imunocompetência , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/microbiologia , Parede Torácica/microbiologia , Tuberculose da Coluna Vertebral/complicações , Antituberculosos/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/tratamento farmacológico , Adulto JovemRESUMO
CASE: We describe a case of septic hip arthritis and enterocutaneous fistula formation caused by the seeding of a hip joint during hip arthroscopy performed in the setting of a psoas abscess. Treatment consisted of multiple debridements and femoral head resection with subsequent total hip arthroplasty. CONCLUSIONS: This case highlights the importance of a thorough history, physical examination, and assessment of available imaging before proceeding to surgery, even when the procedure is one considered to have minimal risks, such as arthroscopy.
Assuntos
Artrite Infecciosa/etiologia , Artroscopia/efeitos adversos , Doença de Crohn/complicações , Fístula Intestinal/complicações , Complicações Pós-Operatórias/etiologia , Abscesso do Psoas/complicações , Adulto , Artrite Infecciosa/diagnóstico por imagem , Erros de Diagnóstico , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Fístula Intestinal/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Abscesso do Psoas/diagnóstico por imagem , RadiografiaRESUMO
BACKGROUND: Psoas or epidural abscesses are often accompanied by pyogenic spondylitis and require drainage. Posterolateral percutaneous endoscopic techniques are usually used for hernia discectomy, but this approach is also useful in some cases of psoas or lumbar ventral epidural abscess. We here report a case of psoas and epidural abscesses accompanied by pyogenic spondylitis that was successfully treated by percutaneous endoscopic drainage. CASE PRESENTATION: Our patient was a 57-year-old Japanese woman who had been receiving chemotherapy for inflammatory breast cancer and who became unable to walk due to lower back and left leg pain. She was transported as an emergency to another hospital. Magnetic resonance imaging revealed psoas and epidural abscesses accompanied by pyogenic spondylitis, and methicillin-resistant Staphylococcus aureus was detected in a blood culture. Drainage of the psoas abscess was performed under echo guidance, but was not effective, and she was transferred to our institution. We performed percutaneous endoscopic drainage for the psoas and epidural abscesses. Immediate pain relief was achieved and the inflammatory reaction subsided after 8 weeks of antibiotic therapy with daptomycin. CONCLUSIONS: Percutaneous endoscopy allowed us to approach the psoas and epidural abscesses directly, enabling the immediate drainage of the abscesses with less burden on the patient.
Assuntos
Drenagem/métodos , Abscesso Epidural/cirurgia , Abscesso do Psoas/cirurgia , Endoscopia/métodos , Abscesso Epidural/complicações , Abscesso Epidural/diagnóstico por imagem , Abscesso Epidural/patologia , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Abscesso do Psoas/complicações , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/patologia , Espondilite/complicações , Infecções Estafilocócicas/sangue , Infecções Estafilocócicas/complicaçõesRESUMO
This article details the treatment of lymphangioma of the face with intralesional bleomycin: with a case report and literature review. Surgical treatment of lymphangioma of the face is a difficult task to achieve, due to close vicinity of the lesion to the facial nerve and possibility of scar tissue formation. Inefficient surgical removals generally will give rise to high recurrence rates because of infiltrative and diffuse extension of the lesion. However, complete cure has been described by non-surgical methods with intralesional bleomycin injection under ultrasonographic guidance. Lymphangioma is a rare congenital malformation of the lymphatic system, frequently seen in the head and neck. Percutaneous sclerotherapy of lymphangioma involves the injection of sclerosing substances into the lymphangioma. This study aims to evaluate the effectiveness of intralesional bleomycin sclerotherapy in the treatment of lymphangioma, and to determine the incidence of complications in the treatment. Intralesional bleomycin therapy was very effective in the treatment of lymphangioma. Bleomycin administered as intralesional injection was found to be safe as there was no lesions complicating or side effects observed in the study.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Drenagem , Estudos Retrospectivos , Resultado do Tratamento , Abscesso do Psoas/terapia , Abscesso do Psoas/diagnóstico por imagem , AntibioticoprofilaxiaRESUMO
We report a case of a 33-year-old woman from Nepal who presented to a hospital with paraplegia. She was found to have pulmonary tuberculosis (TB) with lumbar spine involvement, and bilateral psoas abscesses. She had no initial symptoms attributable to pulmonary involvement. Her delayed presentation to the hospital led to complication of TB spine, which compromised the life of this woman working as a labourer. Early diagnosis and treatment of extrapulmonary TB is essential. Awareness regarding symptoms of different forms of extrapulmonary TB and making diagnostic modalities such as CT scan, MRI or biopsy readily available through insurance schemes are some important measures to minimise the problem so that complications like paraplegia as in our patient with spinal TB can potentially be avoided.