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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Managing spondylitis tuberculosis in a patient with underlying diabetes and hypothyroidism: A case report
Bernadette Dian Novita, Ari Christy Muliono, Sumi Wijaya, Imelda Theodora, Yudy Tjahjono, Vincentius Diamantino Supit, Vincentius Michael Willianto
Bernadette Dian Novita, Department of Pharmacology and Therapy, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya 60113, East Java, Indonesia
Ari Christy Muliono, Department of Internal Medicine, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya 60113, Indonesia
Ari Christy Muliono, Department of Internal Medicine, Premier Surabaya Hospital, Surabaya 60111, Indonesia
Ari Christy Muliono, Department of Internal Medicine, Gotong Royong Surabaya Hospital, Surabaya 60110, Indonesia
Sumi Wijaya, Yudy Tjahjono, Faculty of Pharmacy, Widya Mandala Surabaya Catholic University, Surabaya 60113, Indonesia
Imelda Theodora, Department of Pathology Anatomy, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya 60113, Indonesia
Vincentius Diamantino Supit, Department of Emergency Medicine, Gotong Royong Surabaya Hospital, Surabaya 60110, Indonesia
Vincentius Michael Willianto, Department of General Medicine, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya 60113, Indonesia
Author contributions: Novita BD was responsible for the organization and coordination of the report; Muliono AC was the attending physician for the patient, and responsible for collecting and analyzing the data; Theodora I was responsible for interpreting the diagnostic results; Wijaya S, Tjahjono Y, Supit VD, and Willianto VM were responsible for collecting and analyzing the data; all authors contributed to the writing of the final manuscript; all members of the Spondylitis Tuberculosis-Study Team contributed to the management or administration of the trial.
Informed consent statement: Informed consent was obtained from the patient for the publication of this case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Bernadette Dian Novita, MD, MSc, PhD, Senior Lecturer, Department of Pharmacology and Therapy, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Raya Kalisari Selatan No.1 Pakuwon City, Surabaya 60113, East Java, Indonesia. novita@ukwms.ac.id
Received: October 31, 2021
Peer-review started: October 31, 2021
First decision: December 27, 2021
Revised: December 29, 2021
Accepted: June 15, 2022
Article in press: June 15, 2022
Published online: July 26, 2022
Processing time: 252 Days and 18.1 Hours
BACKGROUND
Tuberculosis (TB) remains one of the highest Asia’s health problems. Spondylitis TB in diabetes mellitus (DM) and hypothyroidism patients is a rare case of extrapulmonary tuberculosis. However, there is a lack of therapeutic guidelines to treat spondylitis TB, particularly with type 2 DM (T2DM) and hypothyroidism as comorbidities. Here we present a case of spondylitis TB with T2DM and hypothyroidism in a relatively young patient and its therapeutic procedure.
CASE SUMMARY
We report the case of a 35-year-old male patient from Surabaya, Indonesia. Based on anamnesis, physical examination, and magnetic resonance imaging, the patient has been categorized in stage II of spondylitis TB with grade 1 paraplegia. Surprisingly, the patient also had a high HbA1c level, high thyroid stimulating hormone, and low free T4 (FT4), which indicated T2DM and hypothyroidism. A granulomatous process was observed in the histopathological section. The antituberculosis drugs isoniazid and rifampicin were given. In addition, insulin, empagliflozin, and linagliptin were given to control hyperglycemia conditions, and also levothyroxine to control hypothyroidism.
CONCLUSION
The outcome was satisfactory. The patient was able to do daily activities without pain and maintained normal glycemic and thyroid levels. For such cases, we recommend the treatment of spondylitis TB by spinal surgery, together with T2DM and hypothyroidism therapies, to improve the patients’ condition. Prompt early and non-invasive diagnoses and therapy are necessary.
Core Tip: Mycobacterium tuberculosis is an infectious pathogen that causes pulmonary and extrapulmonary tuberculosis. We herein present a case of spondylitis tuberculosis in a 35-year-old patient with diabetes mellitus and hypothyroidism that had just known when the patient was hospitalized. Mycobacterium tuberculosis was isolated from both the capsule and pus of the surgically excised abscess in the spinal cord at T9-10 levels. This case highlights the ultimate importance to do prompt early and non-invasive diagnoses and therapy in extrapulmonary tuberculosis.
