Tuberculous spondylodiscitis in a dermatomyositis patient

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Dermatomyositis (DM) is a rare autoimmune disease characterized by symmetrical, progressive weakness of the proximal girdle muscles(1). The mainstay treatment consists of corticosteroids and immunosuppressants that may increase the risk of infections, including tuberculosis (TB)(2). A 64-year-old patient with DM on mycophenolate mofetil and methylprednisolone presented with productive cough, vesperal fever with partial response to common antipyretics, weight loss. Thoracic CT scan was highly suggestive of miliary tuberculosis, later confirmed by sputum examination

Shortly after initiating the complete tuberculostatic regimen, the patient reports intense lumbar pain with irradiation in the gluteal region and in the lower left limb, with Frankel B paraplegia for which a dorso-lumbar spine MRI is performed. The latter showed L4-L5 spondylodiscitis with a tendency to block formation and intervertebral and right paravertebral abscess L4-L5 with cloison-like appearance. The patient is transferred to a specialized service for rehabilitation, decompression of L4-L5, arthrodesis and posterior fixation of L1-S1, with favourable postoperative evolution.

The diagnosis of pulmonary TB led to the identification of the vertebral complication using MRI. Delaying the diagnosis of infectious spondylitis can lead to irreversible complications, like deformity or neurological sequelae with difficult recovery of patients(3). The case highlights the need for TB screening in patients on long-term immunosuppressive and corticosteroid therapy living in endemic countries, especially since they can develop atypical, extra-pulmonary forms of TB.