Tuberculous Spondylitis (Pott’s Disease)

A 46-year old Caucasian male nurse presented with a 12-month history of myalgias and leg weakness, remitting thoracic and lumbar back pain, fever, weight loss and night sweats. Blood tests revealed elevated inflammatory activity and anemia. Suspecting vasculitis, an 18F-fluorodeoxyglucose positron-emission tomographic (18FDG-PET) scan was performed, which demonstrated enhanced uptake in the thoracic and lumbar spine (Figure a). Consistent with these findings, computed tomography (CT) of the spine revealed a large paravertebral abscess (Figure b and Figure c, white arrow) as well as severe spondylodiscitis with destruction of the vertebrae Th 7 and L 1 (Figure c, black arrow). Additionally, CT detected osteolytic lesions of the pelvis, multiple pulmonary lesions and mediastinal lymphadenopathy. The paravertebral abscess was drained and histological examination (Figure d, HE, original magnification × 100) demonstrated epitheloidgranulomatous (black arrow) and necrotizing inflammation (white arrow). Polymerase chain reaction and culture of the paravertebral and sputum specimens revealed infection with Mycobacterium tuberculosis. Radiological and microbiological findings thus indicated the diagnosis of tuberculous spondylitis (Pott's disease) resulting from disseminated postprimary pulmonary tuberculosis. Treatment was started with isoniazid, ethambutol, rifampicin and pyrazinamide. Symptoms improved markedly after several weeks and the patient recovered well. CT scans performed after 3, 6 and 9 months demonstrated regression of all lesions.

The spine is the most frequent site of osseous tuberculous with predominant affection of the upper lumbar and lower thoracic spine. The infection commonly begins in the anterior part of the vertrebal bodies and subsequently involves the disk space, adjoining ligaments and soft tissues. Spinal tuberculosis is frequently accompanied by paraspinal abscesses.