16/M : Boy presented with long standing sub occipital pain for a period of 3 months. He also gave an history of loss of weight of about 10kg, loss of appetite and evening fever. On examination his neck was stiff and unable to move his neck. He was holding his head by supporting his chin. On evaluation he was found to have a grossly damaged C2 bone (both front body and posterior structures) with subluxation happening at C2-3 level and an unstable spine. He also showed pre and paravertebral collections suggesting of pus. His mri also showed skip Lesions involving the T4 and T5 level. Esr was elevated to 80, CRP was elevated to 3. Lymphocytes elevated with relative neutropenia. The MRI and other findings were suggestive of Tuberculosis. He was planned for biopsy, stabilisation considering the 1.unstable nature of Spine 2. To confirm diagnosis 3. To identify the sensitivity pattern of the organisms. He underwent Occipito cervical fusion and the microbiological test like Gene expert, TB culture and sensitivity came as TB sensitive to rifampicin. His biopsy was also correlated to TB as granulomatous inflammation with caseous necrosis. He was mobilised the very next day and got discharged from hospital on 3rd day with anti Tubercular medicines based on his weight. Isoniazid, Rifampicin, Pyrazinamide and Ethambutol drugs were started and tapered tapered to Isoniazid and Rifampicin over a period of months and these two drugs were continued for 1 year. He was absolutely fine, and healthy at end of 2 years.
