Tuberculosis of the Sacrum: Our Experience and Review of the Literature

Tuberculosis of the sacrum is a rare disease, despite spinal tuberculosis being the common form of the extra pulmonary disease. More commonly, tuberculosis involves thoracic or lumbar or the cervical spine. We report a case of sacral tuberculosis with a huge cold abscess over the left lumbar and gluteal region in a male, aged 18 years. CT scan revealed features of significant erosion of the sacrum and large volume abscess in the sacral and lumbar region communicating with each other. Anti-tubercular therapy was started. The patient underwent surgical drainage of the abscess. The purulent fluid was positive for acid-fast bacillus, and CB-NAAT test confirming the diagnosis of sacral tuberculosis. The patient recovered uneventfully and was discharged on anti-tubercular therapy for 9 months with follow-up protocol. The 2-month follow-up is marked with clinical improvement. In developing country like ours, sacral tuberculosis must be considered as first in the differential diagnosis in patients presenting with cold abscess and radiological features of sacral lesions.