Presentation
Back pain, paraparesis, kyphotic deformity and weight loss.
Patient Data
A wedge collapse of T7 vertebra with resultant gibbus deformity of the dorsal spine. Post gadolinium evaluation shows patchy enhancement of T5-T9 vertebrae as well as L4 vertebra consistent with inflammatory changes. A large multiloculated prevertebral and paravertebral collection with well-defined enhancing margins spanning from T6-T9 vertebrae. There is epidural extension via the neuroforamina pathway. This suggests further collection. Significant spinal cord compression is noted.
The diagnosis of tuberculous spondylitis was made given the clinical history, demographics and MRI findings.
Case Discussion
Tuberculous spondylitis, also known as Pott disease refers to vertebral body osteomyelitis and discitis from tuberculosis. The spine is affected in more than 50% of cases of musculoskeletal tuberculosis 1. The thoracic segments are commonly involved followed by the lumbar segments 2. Clinical presentations includes back pain, lower limb weakness or paraplegia, kyphotic deformity and constitutional symptoms as in this case.
The MRI findings are highly suggestive of tuberculous spondylitis which was subsequently confirmed by AFB culture.
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