Multilevel Pre-extensively Drug-resistant Tubercular Spondylodiscitis: Underdiagnosed or Overlooked? A Case Report.

INTRODUCTION: Pre-extensively drug-resistant tuberculosis (TB) is characterized by resistance to either a fluoroquinolone (FQ) or a second-line injectable but not both. The urgent need for prompt diagnosis and targeted treatment is emphasized. This report aims to spotlight a case of spinal TB with insufficient assessment, resulting in delayed definitive treatment and an oversight contributing to heightened morbidity.

CASE REPORT: An 18-year-old female who was initially diagnosed to have multidrug-resistant TB leading to a 2-year treatment which eventually resulted in multifocal involvement of the spine revealing TB relapse with FQ resistance, categorized as pre-extensively drug-resistant TB. Treatment was shifted to newer drugs, addressing challenges like bilateral psoas abscess, which lead to clinical improvement, allowing the patient to make a good recovery.

CONCLUSION: This case report emphasizes the significance of conducting culture and drug sensitivity testing in patients with tubercular spondylodiscitis. The aim is to prevent misdiagnosis and ensure informed decisions regarding definitive medical treatment or surgical management when necessary.