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First Case of Multidrug Resistant Spinal TB in Ireland.

A 23-year-old Somalian lady (residing in Ireland for 9 years) presented with right shoulder pain. Otherwise asymptomatic, she had no medical history. A right apical lung lesion on shoulder X-ray was suspicious for TB. Quantiferon assay was positive, and first line anti-TB therapy was commenced – isoniazid, rifamipicin, pyrazinamide and ethambutol. Unable to produce sputum spontaneously, bronchoscopy with biopsy and bronchoalveolar lavage (BAL) was performed. 4 weeks later, she represented with bilateral lower limb weakness and paraesthesia. MRI spine demonstrated a large thoracic paravertebral abscess causing spinal cord compression, and osteomyelitis. CT-guided biopsy of the abscess was performed, and GeneXpert confirmed the lesion to be tuberculous in nature, demonstrating resistance to isoniazid and rifampicin.