A Case of Posttraumatic Pott's Disease

Abstract

Tuberculosis infection, which is caused by the bacterium Mycobacterium tuberculosis (Mtb), most commonly manifests in patients with respiratory systems. However, it can also colonize other tissues including skeletal. In our case, a 77-year-old Caucasian male presented to the emergency department following a rollover motor vehicle collision with chief complaints of neck and lower back pain. After clinical improvement and a preliminary negative workup, the patient was deemed stable for discharge. Four months later, the patient was subsequently admitted for worsening back pain with workup suspicious for T9 and T10 discitis osteomyelitis and abscess formation on computed tomography (CT). During this admission, spinal Mtb was confirmed by acid-fast stain and real-time polymerase chain reaction of a CT-guided disc space aspirate of a left paraspinal cystic collection at approximately T9-T10. Given these findings, the patient was subsequently put on standard four-drug therapy for Mtb. Our case demonstrates the importance of considering Pott's disease in the diagnosis of lumbar spinal pain, especially in patients living in areas with high international migration and travel.

Keywords: pott’s disease; skeletal tuberculosis; spinal trauma; spinal tuberculosis:; tuberculosis; tuberculosis spondylitis.

Figure 1. Computed tomography sagittal view of the thoracic spine from the initial visit

This demonstrates bony destruction of the T9 and T10 endplates.

Figure 2. Computed tomography coronal view of the thoracic spine from the initial visit

This demonstrates bony destruction of the T9 vertebral body.

Figure 3. Computed tomography axial view of the thoracic spine during subsequent admission

This demonstrates significant worsening bony destruction of the T9-T10 vertebral bodies involving the adjacent endplates. There is additional prevertebral soft tissue edema.