Atypical Presentation of Cervical Pott’s Disease: A Case Report

Abstract

Tuberculous spondylitis, also known as Pott's disease, is due to infection of the spine by mycobacterium tuberculosis (MTB) leading to vertebral body and inter-vertebral disc destruction. It is the most common form of musculoskeletal tuberculosis most frequently affecting the thoracolumbar spine and is commoner in young people. Onset of this condition is insidious and its clinical presentation is non specific. However, Pott's disease may be complicated by neurologic deficits including paraplegia or even quadriplegia, with huge health, economic and psychological burden. Following is a case report of Pott's disease involving the cervical spine in a 33-year old farmer presenting unusually with paraplegia and a negative Mantoux test. It is reported because this very uncommon condition is highly treatable, and there is need for a raised index of suspicion in order to diagnose this condition early, thus limiting its complications. The role of MRI in diagnosis of Pott's disease is also highlighted.

Non-contiguous Rare Presentation of Spinal Tuberculosis: A Case Report

“…Spinal TB has a favorable prognosis if treated early, with a cure rate of 90% [ 7 ]. In our case, the initiation of antibiotic therapy was delayed until confirmation of TB infection based on the pathology results due to an uncertain diagnosis.…”

“…Anti-TB agents are the cornerstone of spinal TB treatment, with combination therapy of four drugs: isoniazid, rifampicin, pyrazinamide, and ethambutol. All four are administered for the first two months, followed by isoniazid and rifampicin for the subsequent 10 months, with a total treatment duration of 12 months [ 7 ]. Surgery is recommended only when necessary, such as in cases with neurological issues, spinal instability, significant kyphosis, refractory pain, or medical treatment failure.…”

“…Spinal TB can lead to vertebral collapse, spinal deformity, paraspinal abscesses, and neurological complications due to cord compression [ 6 ]. Constitutional symptoms, such as fever and weight loss, have also been reported in the literature [ 7 ]. The typical pattern of spinal TB is the contiguous involvement of two or more vertebrae with the destruction of the intervening disc [ 6 ].…”

Atypical Cervical Potts Spine with Multiple Level Epidural Collection: A Case Series of Three Patients

“…Pott’s disease accounts for about 1%–2% of all cases of TB [ 1 ]. Cervical Pott’s constitutes about 10% of all Pott’s spine cases [ 1 ].…”

“…Pott’s disease accounts for about 1%–2% of all cases of TB [ 1 ]. Cervical Pott’s constitutes about 10% of all Pott’s spine cases [ 1 ]. Furthermore, cases of cervical Pott’s spine with multiple level involvement are even lesser and collection ventral to the cord is even less common than dorsal collection as pus is more likely to accumulate in larger epidural spaces that contain infection prone fat [ 2 , 3 ].…”