Uncommon cause of cervicobrachial neuralgia: epidural abscess complicating tuberculous arthritis.

Kouki S, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-219458 Description A 59-year-old patient was admitted to the rheumatology department with cervicobrachial neuralgia in the upper extremities and paresthesia. The symptoms appeared 3 months ago. Physical examination showed neck stiffness with decreased sensitivity in the territory of the C4 root in both arms. There was no motor weakness or fever. The inflammatory blood markers were increased. Spinal MRI was performed showing posterior epidural collection hyperintense in T2-weighted images (figure 1) with intense peripheral enhancement extending from C3-C4 to C4-C5 (figure 2). A facet joint arthritis at the level of C3-C4 was also noticed with a T2 hyperintense lesion of the spinal cord (figure 1). The patient was immediately referred to surgery. The surgical treatment consisted of cervical laminotomy with drainage of the epidural collection. The culture of the abscess fluid revealed Mycobacterium tuberculosis. Long-lasting antituberculosis treatment was prescribed in addition to surgical treatment. Cervical facet joint arthritis with epidural abscess is a rare condition. Itusually occurs after a local infection, trauma or surgical procedure. 2 Patients with immunodeficiency and diabetes mellitus are often concerned. The most involved germ is Staphylococcus aureus. The epidural abscess can be responsible for spinal cord compression or nerve root impingement. The management of cervical arthritis and epidural abscess is controversial. Some authors recommend starting with intravenous antibiotherapy especially in patients without medical history. Other associate antibiotics and CT-guided drainage of the epidural abscess. Surgical treatment is needed in case of medullar Uncommon cause of cervicobrachial neuralgia: epidural abscess complicating tuberculous arthritis Sami Kouki, Manel Landolsi, Mehdi Ben Lassoued, Imen Gharsallah