Uncommon cause of cervicobrachial neuralgia: epidural abscess complicating tuberculous arthritis

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).

Figure 1

T2-weighted sagittal and axis images showing posterior epidural mass with mass effect on the spinal cord at C3-C4 and medullar oedema.

Figure 2

T1FAT SAT post-gadolinium axial images showing intense...

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