Case Report Article

Spinal tuberculosis with concomitant tuberculosis psoas abscesses in a young male. A rare case of extrapulmonary tuberculosis

Irena Karabella, Maria Meliou

• “Sotiria” General Hospital of Diseases of the Thorax, Athens, Greece

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Keywords: Mycobacterium tuberculosis, Tuberculosis, Spondylitis, Psoas abscess, Pott’s disease

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Abstract

We report a case of spinal tuberculosis with concomitant presence of tuberculosis psoas abscesses. A 27 yearold male patient presented with 10month history of lower back pain and a recently appeared, increasing in size, gluteal mass. Patient appeared with low-grade fever and mildly elevated inflammation markers. Magnetic resonance imaging (MRI) revealed the two psoas abscesses and spondylitis of T12-L1 vertebrae. Drainage of the largest abscess was performed, samples were cultured and PCR for mycobacterium tuberculosis was performed. After the positive result from PCR and exclusion of concomitant tuberculosis of other organs the patient was treated with isoniazid, rifampicin, ethambutol and pyrazinamide and the use of spinal orthotics for stabilization of the spine. Culture results confirmed the diagnosis of spinal tuberculosis. Patient was followed up during the year he received the treatment and remained asymptomatic with improvement of imaging findings. Pott’s disease accounts for a small percentage of all tuberculosis cases, while skeletal tuberculosis accounts for almost half of extra-pulmonary tuberculosis. Among spinal tuberculosis patients only a 5% suffers from concomitant psoas abscesses. Since skeletal tuberculosis has an insidious clinical course and can lead to serious disability if undiagnosed, high clinical suspicion by the physician is essential for early diagnosis and management.

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