Presentation
Neck pain.
Patient Data
A destructive process involves the C2 vertebral body and base of dens with a pathological fracture. It is associated with significant surrounding soft tissue swelling.
A destructive process affects C2 particularly on the left with peripheral enhancement and central non-enhancement. A small amount of epidural extension is seen contacting but not compressing the cord. Prevertebral swelling. The differential is of metastasis or infection. The degree of swelling favors the later, especially in the absence of known malignancy and in this age group.
Case Discussion
The patient went on to have a biopsy.
Microbiology
DNA amplification assay for M.tuberculosis complex (PCR): DETECTED
Mycobacterium culture screen (MGIT bottle 15 days ): POSITIVE
Mycobacterium culture: Acid Fast Bacilli: ISOLATED