A Case Report of Disseminated Pott’s Disease (Spinal Tuberculosis) Complicated by Abscess and Near Complete Destruction of Cervical Spine (C5, C6)

Special Article – Tuberculosis

Austin Med Sci. 2020; 5(1): 1040.

A Case Report of Disseminated Pott’s Disease (Spinal Tuberculosis) Complicated by Abscess and Near Complete Destruction of Cervical Spine (C5, C6)

Satti HMA1* and Mohamed FAA2

¹Internal Medicine Resident Registrar, Sudan Medical Specialization Board, Sudan

²Emergency Medicine Resident, Ribat University Hospital, Sudan

*Corresponding author: Hassan Mohammed Abdelraheem Satti, Internal Medicine Resident Registrar, Sudan Medical Specialization Board, Sudan

Received: January 14, 2020; Accepted: February 24, 2020; Published: March 02, 2020


Potts disease (PD) or spinal tuberculosis is a rare infectious disease, which is commonly spread from extra-spinal infection. It commonly involves the anterior aspect of multiple vertebrae. The most common affected site is the lower thoracic vertebrae, with the cervical vertebrae the least common site but has the most serious complication. Back pain is the earliest and most common symptom, along with other constitutional symptoms like fever, night sweating and weight loss. Other presentations depend on the stage of disease and the occurrence of complication. The most sensitive diagnostic modality is Magnetic resonance imaging (MRI) which demonstrates features of spondylodiscitis, disc collapse and disc destruction, cold abscess, vertebral wedging, vertebral collapse and spinal deformities. Histopathological analysis can be done by Ultrasound and computed tomographic (CT) guided needle aspiration or biopsy. Treatment is by combination Anti-Tuberculosis and surgery (debridement, decompression, fusion and bone auto-graft) in case of complication. A 55 years old man presented complain of dull back pain that started three weeks prior to admission along with fever and night sweating, one week later he started to develop neurological complication in form of lower limb weakness, his condition deteriorated gradually to the level of complete paraplegia and he also had urine retention. Diagnosis of pott’s disease was confirm based on MRI imaging and microscopically analysis of a needle aspiration sample. Patient was treated with a combination Anti-Tuberculosis and underwent surgery (decompression and fixation).

Keywords: Pott’s disease; Tuberculosis; Abscess; Neurological deficit; MRI


Tuberculosis (TB) is considered a disease most prevalent among people with low socioeconomic status and so found mostly in underdeveloped countries. TB may involve any part of the body like; skin, lungs, brain, bones and intestines. Spinal TB is commonest type of tuberculosis involving the bony element, and it is called pott’s disease (PD). It may spread to the spine from the lungs and abdomen or it may manifest as primary disease [1]. The clinical presentation of PD depends on the Stage of disease, the affected site and the Presence of complications such as neurologic deficits, abscesses, or sinus tracts [2]. Diagnosis depends on the presence of characteristic clinical manifestations and neuroimaging findings. Etiological confirmation requires the demonstration of acid-fast bacilli on microscopy or culture of material obtained from the lesion.

Case Presentation

55 years old male farmer from El Gezira (middle Sudan) known to have diabetes mellitus type two for 10 years on insulin, presented complain of low grade fever that started 25 days prior to admission, fever was mainly at night and associated with sweating. Two days later he started to have dull back pain, mainly at cervical and lumbar region. Then after seven days, he started to develop lower limb weakness that deteriorated gradually to the level of complete paraplegia. In addition, the patient began to have urine retention in the last two days prior to admission. Patient had no history of cough or shortness of breath; also, he had no history of close contact with a patient with tuberculosis or chronic cough. Regarding other systemic review he has no complains. Patient is not smoker or alcohol consumer.

Examination at the date of admission showed the followings; patient was very ill, pale, not jaundice, not dyspneic, oriented in time place and person, blood pressure 117/55. Pulse rate 110/min (regular, large volume, synchronize, no radio-femoral delay), respiratory rate 18/min, spo2: 100%, temperature: 38C, jugular venous pressure (JVP) not raised. Pulmonary examination: normal air entry bilaterally, normal vesicular breathing, no crepitation or wheezing. Cardiac examination: normal S1 and S2 no added sound. Abdominal examination: no abnormalities detected. Back examination: tenderness in lumbar and cervical regions, no deformities. Neurological examination: Glasgow coma scale (GCS) was 15/15, cranial nerves examination were intact, upper limbs examination (power grade five, normal tone and reflexes, sensation was intact), Bilateral lower limbs examination (power grade zero, hypo-tonia and hypo-reflexes, sensation was diminished) (Table 1).