Mark Tornero, MD
Director of Stroke Rehabilitation; Director of Amputee Rehabilitation
The Ohio State University Medical Center
New Albany, Ohio, United States
August Runyon, DO
Presenting Author
Ohio State University Wexner Medical Center
Dublin, Ohio, United States
A male presented with symptoms of worsening abdominal distension, cough, fever, and weight loss. He eventually underwent QuantiFERON testing, a left thoracentesis, AFB sputum cultures, and PCR testing to diagnose mycobacterium avium intracellulare complex.
He was prescribed multi-drug treatment with linezolid, moxifloxacin, ethambutol, pyridoxine and rifampin, but developed worsening lower limb weakness, neurogenic bladder, and obstipation. He was found to have a thoracic abscess causing significant cord compression and required a T5 through T8 decompressive laminectomy.
As time evolved he developed worsening weakness, and further imaging found osteomyelitis throughout the spine and pelvis and soft tissue abscesses in the psoas and iliacus, and presacral space. A tuberculoma was also in the epidural space at the L4 vertebral body level causing severe compression of the thecal sac which was narrowed to 3 mm requiring a bilateral decompressive laminectomy, microdiscectomy, as well as the mass removal.
Discussions:
This individual had a low compliance rate and had parted with medical care multiple times over the course of a year. More recently though, communication efforts with the patient became more empathic and comprehensive to involve multiple teams ranging from physician specialists, rehabilitation providers, and neuropsychologists who used more comprehensive methods to communicate to the patient their medical complications, and strategies to keep an open line of communication between them and family.
Conclusions:
We’ll discuss literature on psychosocial multidisciplinary efforts to maintain a direct line of communication with an individual to help them remain engaged in their medical treatments to avoid unnecessary health consequences such as severe cord compression and irreversible paralysis. We’ll also discuss screening guidelines in individuals with disseminated tuberculosis to determine conditions such as an epidural abscess earlier rather than later.
