Robert Steinberg, BS
Medical Student
NYITCOM
Forest Hills, New York, United States
Daniel Hu, MD
Resident Physician
University of Pennsylvania
Philadelphia, Pennsylvania, United States
Jerry Jacob, MD, MS
Associate Professor of Clinical Medicine
University of Pennsylvania
Philadelphia, Pennsylvania, United States
Betty Chernack, MD
Assistant Professor of Physical Medicine and Rehabilitation
University of Pennsylvania
Philadelphia, Pennsylvania, United States
.jpg "Benjamin Abramoff, MD, MS photo")
Benjamin Abramoff, MD, MS
Physician
Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Disseminated tuberculosis involving the spinal cord (Pott’s Disease)
Case Description:
34-year-old man recently immigrated to the US presented with one month of atraumatic low back pain radiating into RLE. MRI revealed L3-L5 lytic lesions presumed to be secondary to malignancy, and he was discharged with outpatient follow-up. Two months later, CT A/P was performed for worsening back pain and revealed progression of lytic lesions. Thoracolumbar MRI revealed L4-L5 epidural extension involving multiple cauda equina roots. CT chest revealed multiple lung nodules and a soft-tissue mass extending into chest wall musculature. IR biopsy of chest wall mass was performed for infectious vs malignant workup, aspirate grew acid-fast bacilli, and the diagnosis of tuberculosis was confirmed by microbiology. Patient was then started on RIPE therapy and underwent L4-S1 laminectomy with resection of epidural lesion. Patient was discharged to inpatient rehabilitation where he experienced new RLE weakness consistent with paradoxical inflammatory reaction to treatment. He improved following steroid taper and designated rehabilitation regimen.
Discussions:
Pott’s Disease, or disseminated tuberculosis involving the spine, is a rare cause of spinal cord compression making up 1-5% of all cases of tuberculosis. This case highlights the importance of maintaining a high index of suspicion for spinal tuberculosis, particularly in patients from endemic regions presenting with atraumatic symptoms of spinal cord injury. This patient’s clinical course continued to deteriorate until the diagnosis was confirmed and appropriate therapy was initiated, highlighting the importance of the interdisciplinary diagnostic approach involving PM&R, medicine, neurology, neurosurgery, and infectious disease. Once the diagnosis was established, functional improvement was attained with appropriate pharmacologic therapy along with an intensive rehabilitation regimen involving PT/OT.
Conclusions:
Spinal tuberculosis should be considered on the differential for patients exhibiting signs of atraumatic spinal cord compression, and an interdisciplinary approach in both the diagnostic and rehabilitative process is crucial to optimize outcomes.
