ABSTRACT
INTRODUCTION: Spinal Tuberculosis (STB) represents between 1% and 2% of total tuberculosis cases. STB management remains challenging; the first-line approach consists of medical treatment, while surgery is reserved for patients with complications. No data regarding STB treatment with bedaquiline-containing regimens are available in the literature. CASE DESCRIPTION: Herein, we report the case of a 21-year-old man from Côte d'Ivoire with a multidrug resistance STB with subcutaneous abscess. After approval of the hospital off-label drug committee, we started bedaquiline 400 mg daily for two weeks, followed by 200 mg three times per week, for 22 weeks, associated with linezolid 600 mg daily, rifabutin 450 mg daily, and amikacin 750 mg daily (interrupted after eight weeks). During treatment, we performed a weekly EKG. No QT prolongation was shown, but inverted T waves appeared, requiring several cardiological consultations and cardiac MRI, but no cardiac dysfunction was found. After 24 weeks, bedaquiline was replaced with moxifloxacin 400 mg daily. The patient continued treatment for another year. We performed another computer tomography at the end of treatment, confirming the cure. DISCUSSION: A salvage regimen containing bedaquiline proved effective in treating multidrug-resistance tuberculosis spinal infection without causing severe adverse effects. However, further studies are needed to evaluate better bedaquiline bone penetration and the correct duration of treatment with bedaquiline in MDR spinal tuberculosis.
Subject(s)
Mycobacterium tuberculosis , Osteomyelitis , Tuberculosis, Multidrug-Resistant , Tuberculosis, Spinal , Abscess/drug therapy , Adult , Amikacin/pharmacology , Amikacin/therapeutic use , Antitubercular Agents/adverse effects , Diarylquinolines/pharmacology , Diarylquinolines/therapeutic use , Humans , Linezolid/pharmacology , Male , Moxifloxacin/pharmacology , Moxifloxacin/therapeutic use , Off-Label Use , Osteomyelitis/drug therapy , Rifabutin/pharmacology , Rifabutin/therapeutic use , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Spinal/chemically induced , Tuberculosis, Spinal/diagnostic imaging , Tuberculosis, Spinal/drug therapy , Young AdultABSTRACT
A 74-year-old man underwent intravesical bacillus Calmette-Guerin (BCG) therapy for bladder cancer and later presented with lower left back pain. Magnetic resonance imaging of the spine showed high signal intensity, diagnosed as a cystic lesion in the epidural and bilateral intestinal psoas muscle. A computed tomography-guided needle biopsy and histological examination revealed bacteria from the family Mycobacteriaceae, and Mycobacterium bovis was identified using multiplex polymerase chain reaction. If lower back pain appears in a patient who has undergone BCG therapy, it is necessary to test for tuberculous spondylitis. In addition, QuantiFERON is useful for the differential diagnosis of M. bovis BCG infection.