To the Editor: Although the clinical history and images of tuberculosiswith Pott's disease presented by Weber and Scherübl (Dec.5 issue)1 were instructive, I believe their reference to theLangerhans' cell was incorrect. The characteristic cell of thetuberculous granuloma is the Langhans' giant cell. The Langerhans'giant cell refers to the dendritic antigen-processing cell ofthe Langerhans' cell granulomatoses, formerly known as eosinophilicgranulomas. Students of pathology may find it helpful to recallthe "e" in both Langerhans and eosinophilic granuloma.
Vincent J. Vigorita, M.D. Lutheran Medical Center Brooklyn, NY 11220 vvigorita{at}lmcmc.com
References
Weber U, Scherübl H. Tuberculosis with atlantoaxial and craniovertebral Pott's disease. N Engl J Med 2002;347:1849-1849. [Free Full Text]
To the Editor: Weber and Scherübl present an excellentcomputed tomographic image of changes in the upper cervicalspine in a patient with tuberculosis and Pott's disease. However,we disagree with the authors that the scan shows lateral subluxationof the dens axis as the result of a fracture of the left lateralatlas. Our opinion is that the scan shows lateral subluxationof the atlas; the dens axis is still in the right place abovethe rest of the body. True lateral subluxation of the dens axiswould need a fracture in the dens or other pathologic processesin the axis, which the authors do not mention. Furthermore,lateral subluxation of the dens axis cannot be the result ofa fracture in the atlas.
Kari Laiho, M.D. Markku Kauppi, M.D., Ph.D. Irma Soini, M.D., Ph.D. Rheumatism Foundation Hospital FIN-18120 Heinola, Finland
The authors reply: We thank Dr. Vigorita for correctly pointingout that our patient had caseating granulomas containing notonly acid-fast bacilli but also the characteristic Langhans'giant cells. We agree with Dr. Laiho and colleagues that thedens axis was not fractured. However, the left massa lateralisatlantis was destroyed (Figure 1). No doubt there was subluxationof both C0–C1 and C1–C2.
Correction
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Weber and Scherübl, 
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