Pott disease causing cauda equina syndrome
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.
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L2/3 diskitis with localized 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.
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The case was discussed with neurosurgeons, who elected for conservative management with a spine brace.
She was commenced on second line antibiotics for diskitis 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.