Article Text

Download PDFPDF

Pott’s disease with paraparesis in a 36-year-old man
  1. Shuzhong Liu1,
  2. Xi Zhou1,
  3. An Song2,
  4. Zhen Huo3,
  5. Yipeng Wang1,
  6. Yong Liu1
  1. 1 Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
  2. 2 Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
  3. 3 Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
  1. Correspondence to Professor Yong Liu, Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing 100730, China; liuyong_pumch{at}163.com

Statistics from Altmetric.com

A 67-year-old man presented to our institution with a 1-day history of aggravated paraparesis and back pain. The physical examination showed decreased sensation to pinprick and fine touch and a 0/5 strength in bilateral lower extremities. Chest radiography showed a mass that appeared to be located in the posterior mediastinum, as well as multiple calcified mediastinal lymph nodes (figure 1A). CT of the chest revealed a paravertebral mass of soft tissue surrounding the vertebra with significant bony destruction of vertebral bodies, which extended from T5 to T6 (figure 1B). MRI demonstrated significant compression and posterior displacement of the spinal cord without infiltration of the mass (figure 1C). No relevant special circumstances regarding his family history or personal history were identified. After a detailed assessment, we performed urgent posterior decompression, excision of space-occupying lesions and internal fixation from T2 to T8, and we sent the specimen of the mass for pathogen culture and pathological examination. The results of Ziehl-Neelsen staining of the tissue were positive, and Mycobacterium tuberculosis grew in a culture of the tissue, indicating Pott’s disease. Based on the criteria, diagnosis of Pott’s disease with paraparesis was considered. We administered antituberculous chemotherapy. One week after the operation, radiographic studies showed that the mass had regressed and the patient’s lower extremities muscle strength improved to grade 5 compared with the preoperative status, grade 0, and the sensation to pinprick and fine touch of bilateral lower extremities almost returned to normal status. At the 2-year follow-up visit, he reported complete remission and no new symptoms.

Figure 1

(A) Chest X-ray showing a mass that appeared to be located in the posterior mediastinum, as well as multiple calcified mediastinal lymph nodes. (B and C) MRI demonstrating a paravertebral mass of soft tissue surrounding the T6 vertebra, significant compression and posterior displacement of the spinal cord without infiltration of the mass.

Pott’s disease is known as spinal involvement of extrapulmonary tuberculosis, and the insidious course of the rare disorder often causes a delay in getting to a timely diagnosis that is not made prior to rising signs, such as large abscess, neurological impairment or vertebral fractures.1 The effects of spinal tuberculosis can be devastating, and early diagnosis and initiation of treatment are necessary to prevent severe neurological complications.1 2 Pott’s disease with paraparesis is less documented in the literature, and the only definitive management is surgical excision of the space-occupying lesions.3 4 The present case highlights the importance of accurate diagnosis and proper treatment for patients with Pott’s disease.

References

View Abstract

Footnotes

  • Contributors SL wrote the first draft of the manuscript and submitted the manuscript. XZ, AS and ZH were in charge of the patient and collected the data. SL and YL did the follow-up of the patient. YW and YL critically revised the manuscript and contributed equally to this paper. All authors approved the final version.

  • Funding This study was funded by National Natural Science Foundation of China (grant no: 81871746) and Peking Union Medical College Graduate Student Innovation Fund (grant no: 2018-1002-02-08).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.