Pott disease

Case contributed by Dr Ahmed Abdrabou

Presentation

Patient with neck pain and right hand numbness.

Patient Data

Age: 25 years
Gender: Male
X-ray

Cervical X ray shows subtle widening of the prevertebral soft tissue shadow anterior to C5 and C6 vertebrae, as well as abnormal lucencies at the anterosuperior C3 and anterior C7 vertebral bodies.

Unfortunately had her cervical x-ray interpreted as normal. After 1 month she was admitted with cachexia and fever and had further imaging. 

One month later

MRI

There was subtotal destruction of C2 and C6 vertebral bodies, and to a lesser degree C5, with extensive marrow edema and enhancement involving the cervical vertebrae down to T2. Nevertheless, there were two large paravertebral abscesses: one opposite the right side of C2 with small epidural component and a larger multiloculated pre- and paravertebral abscess more to the right side with epidural extension through right C6-C7 neural foramen. Moreover, there is an inferior extension reaching the posterior mediastinum. The two abscesses appeared connected. There was gibbus deformity at C6-C7 level.

Case Discussion

The case represents classic findings of Pott disease (TB spondylodiscitis) and paravertebral abscess as evident by involvement of the vertebral body more than the disc, skip lesions, gibbus defomity and paravertebral abscess. Unfortunately the cervical radiograph was misreported as normal and the patient came back after complications were occurred.

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