Pott disease causing cauda equina syndrome

Case contributed by Dr Rishikesan Ramaesh

Presentation

Known discitis. She was initially treated with a prolonged course of IV and oral antibiotics. She represented to the ED with a 4 day history of neuropathic sounding pain around hips, thighs and knees. She had been suffering from recurrent falls. She denies any incontinence.

Patient Data

Age: 75
Gender: Female
Modality: MRI

L2/3 discitis with localised prevertebral, psoas and anterior epidural involvement.

Destruction of the L3 superior endplate, with L3 vertebral body height now approximately 50% of normal. Abnormal enhancing  prevertebral soft tissue at the level of the L2/3 and also abnormal epidural soft tissue at L2/3 which compresses the thecal sac and cauda equina. The urinary bladder is distended.

Case Discussion

The case was discussed with neurosurgeons, who elected for conservative management with a spine brace.

She was commenced on second line antibiotics for discitis and was referred to the regional infectious disease unit for further investigation. The causative agent was found to be Mycobacterium tuberculosis and this lady was commenced on a prolonged course of antimycobacterial therapy.

Extra-pulmonary manifestations of TB are less common than pulmonary presentations, but infiltration of the spine is well described in the literature and is known as Pott disease.

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Case Information

rID: 33009
Case created: 25th Dec 2014
Last edited: 17th Sep 2015
Inclusion in quiz mode: Included

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