Abstract
Tuberculous spondylitis is more common in patients with chronic renal failure who receive hemodialysis because of their abnormal T-cell-mediated immunity. It frequently poses both diagnostic and therapeutic challenges. We describe two cases of tuberculous spondylitis in patients undergoing chronic hemodialysis therapy. They are IFN-γ assay diagnosed (QuantiFERON-TB Gold) and conservatively treated. Our cases suggest that IFN-γ assays equip clinicians with more accurate tools for tuberculosis control. A combination of T-SPOT.TB testing and MRI assessment may be the accurate method to diagnose tuberculous spondylitis in patients with end-stage renal disease.
[1] American Thoracic Society; Centers for Disease Control and Prevention; Infectious Diseases Society of America American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: controlling tuberculosis in the United States. Am J Respir Crit Care Med 2005, 172, 1169–1227 http://dx.doi.org/10.1164/rccm.250800110.1164/rccm.2508001Search in Google Scholar
[2] Chou KJ, Fang HC, Bai KJ, Hwang SJ, Yang WC, Chung HM: Tuberculosis in maintenance dialysis patients. Nephron 2001, 88, 138–143 http://dx.doi.org/10.1159/00004597410.1159/000045974Search in Google Scholar
[3] Passalent L, Khan K, Richardson R, Wang J, Dedier H, Gardam M: Detecting Latent Tuberculosis Infection in Hemodialysis Patients: A Head-to-Head Comparison of the T-SPOT.TB Test, Tuberculin Skin Test, and an Expert Physician Panel Clin J Am Soc Nephrol 2007, 2, 68–73 10.2215/CJN.01280406Search in Google Scholar
[4] Poduval RD, Hammes MD: Tuberculosis screening in dialysis patients: Is the tuberculin test effective? Clin Nephrol 2003, 59, 436–440 10.5414/CNP59436Search in Google Scholar
[5] Khalfallah M, Faure A, Hamel O, Cantarovich D, Doe K, Raoul S, Bord E, Robert R: Dialysis-associated spondyloarthropathy. Case report and literature review. Neurochirurgie 2005, 51, 165–172 http://dx.doi.org/10.1016/S0028-3770(05)83472-110.1016/S0028-3770(05)83472-1Search in Google Scholar
[6] Shankar MS, Aravindan AN, Sohal PM, Kohli HS, Sud K, Gupta KL, Sakhuja V, Jha V: The prevalence of tuberculin sensitivity and anergy in chronic renal failure in an endemic area: Tuberculin test and the risk of post-transplant tuberculosis. Nephrol Dial Transplant 2005, 20, 2720–2724 http://dx.doi.org/10.1093/ndt/gfi14110.1093/ndt/gfi141Search in Google Scholar PubMed
[7] Fang HC, Chou KJ, Chen CL, Lee PT, Chiou YH, Hung SY, Chung HM: Tuberculin skin test and anergy in dialysis patients of a tuberculosis-endemic area. Nephron 2002, 91, 682–687 http://dx.doi.org/10.1159/00006503110.1159/000065031Search in Google Scholar PubMed
[8] Wauters A, Peetermans WE, Van den Brande P, De Moor B, Evenepoel P, Keuleers H, Kuypers D, Stas K, Vanwalleghem J, Vanrenterghem Y, Maes BD: The value of tuberculin skin testing in haemodialysis patients J. Nephrol Dial Transplant 2004, 19, 433–438 http://dx.doi.org/10.1093/ndt/gfg56910.1093/ndt/gfg569Search in Google Scholar PubMed
[9] Aggarwal I: Tuberculosis — diagnosis and investigation. Hospital Pharmacist 2006, 13, 73–78 Search in Google Scholar
[10] Niu CC, Chen WJ, Chen LH, Shih CH: Destructive spondyloarthropathy mimicking spondylitis in long-term hemodialysis patients. Arch Orthop Trauma Surg 2000, 120, 594–597 http://dx.doi.org/10.1007/s00402000013510.1007/s004020000135Search in Google Scholar PubMed
[11] Arend SM, Thijsen SF, Leyten EM, Bouwman JJ, Franken WP, Koster BF, Cobelens FG, van Houte AJ, Bossink AW: Comparison of two interferon-gamma assays and tuberculin skin test for tracing tuberculosis contacts. Am J Respir Crit Care Med 2007, 175, 618–627 http://dx.doi.org/10.1164/rccm.200608-1099OC10.1164/rccm.200608-1099OCSearch in Google Scholar PubMed
[12] Pai M, Lewinsohn DM: Interferon gamma assays for tuberculosis. Is anergy the Achilles’ heel? Am J Respir Crit Care Med 2005, 172, 519–521 http://dx.doi.org/10.1164/rccm.250600310.1164/rccm.2506003Search in Google Scholar PubMed
[13] Brock I, Munk ME, Kok-Jensen A, Andersen P: Performance of whole blood IFN-gamma test for tuberculosis diagnosis based on PPD or the specific antigens ESAT-6 and CFP-10. Int J Tuberc Lung Dis 2001, 5, 462–467 Search in Google Scholar
© 2009 Versita Warsaw
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
