Extensively drug-resistant tuberculosis of the spine: A rare case report

Spinal tuberculosis is the most common form of skeletal extrapulmonary tuberculosis (EPTB). Extensively drug-resistant TB (XDR-TB) is a rare type of multidrug-resistant tuberculosis (MDR-TB) that is resistant to isoniazid and rifampicin, plus any fluoroquinolone and at least one of three second-line injectable drugs (SLI) (i.e., amikacin, kanamycin, or capreomycin) as per the old guidelines.

We present the case of a 13-year-old girl, with lower back pain for 6 months, without other symptoms. She was radiologically diagnosed with tuberculous osteomyelitis without confirmation of acid-fast bacilli. Due to our endemic area, the initial tuberculosis treatment was empiric. The patient received treatment from a private hospital but after 6 months developed lower limb weakness. She was referred to our center where XDR-TB was confirmed by bacteriological examination. She was managed with extended second-line antituberculous chemotherapy according to the new WHO recommendation with a good evolution in the first months of therapy. Appropriate sensitivity-antituberculosis agents and good patient compliance are the keys to ensuring effective treatment of the XDR-TB condition.