혈액 투석 환자에서 발생한 결핵성 척추염 치료

• Published in: Kidney research and clinical practice Vol. 20; no. 6; pp. 1075 - 1079
• Main Authors: 유혜영, Yu Hye Yeong, 신영신, Sin Yeong Sin, 우영식, U Yeong Sig, 최강현, Choe Gang Hyeon, 이정록, Lee Jeong Log, 이소영, Lee So Yeong, 박철휘, Park Cheol Hwi, 안명임, An Myeong Im, 장윤식, Jang Yun Sig, 방병기, Bang Byeong Gi
• Format: Journal Article
• Language: Korean
• Published: 대한신장학회 30.11.2001
• Subjects: Anti Tuberculosis medication; End stage renal disease; Radical excision surgery; Tuberculous spondylitis
• ISSN: 2211-9132

Patients undergoing maintenance dialysis show an increased susceptibility to tuberculosis because host immunity is decreased secondary to malnutrition, impaired cellular immunity, acidosis and etc. Extrapulmonary tuberculosis is more prevalent in patients with end stage renal disease than in normal subjects. Among the extrapulmonary tuberculosis in patients receiving hemodialysis, the diagnosis of tuberculous spondylitis is difficult because the symptoms are non specific and attributable to uremia, and the appearance of plain radiographs is often normal during the early phase of the disease. We experienced a case of tuberculous spondylitis in a hemodialysis patient. A 55 years old female admitted with fever, weight loss and back pain. Conventional radiograph of T-spine showed no definite abnormal finding. However, chest CT revealed heterogeneously enhancing soft tissue around the T8 vertebral body and T-spine MRI showed compatible finding to tuberculous spondylitis. She received radical excision of involved vertebra and confirmed tuberculous spondylitis with histologic finding from a surgical specimen. Following the administration of anti-tuberculosis medication(isoniazid, rifampin, pyraziamide, ethambutol) and radical excision, patient`s symptom and sign were improved. The patient is maintaining dialysis with anti-tuberculosis medication for 5 months.