Infliximab-related tubercular spinal epidural abscess without osseous involvement in a patient with Crohn’s disease: A case report

Abstract

Tubercular spinal epidural abscess without osseous involvement is an extremely rare presentation of spinal tuberculosis. We report a case of perianal Crohn’s disease, who developed a tubercular epidural abscess in lumbosacral spine without osseous involvement, secondary to infliximab administration, despite being on 6 months of antituberculous therapy for perianal tuberculosis even as the primary focus healed well. This is probably the first case of infliximab-related tubercular spinal epidural abscess without osseous involvement. A combination of surgical treatment and antitubercular therapy gives a good outcome. This case highlights the rare and atypical nature of presentation of spinal tuberculosis in this scenario and emphasizes the importance of vigilant follow-up to prevent delayed diagnosis, due to atypical presentations following anti-tumor necrosis factor therapy.

Keywords

• crohn’s disease
• epidural abscess
• extrapulmonary tuberculosis
• infliximab
• paradoxical response
• tuberculosis