Disclosures: Jinpu Li, MD: Nothing to disclose

Case Description: 44-year-old male from Kuwait presented with diffuse bony pain, more so on the mid back, which started about 8 months ago. The pain was dull achy with sharp intensification, aggravated by movement; acetaminophen provided no relief. Endorsed weight loss and general weakness. Denied fever/night sweat/bowel or bladder issues. Tender to percussion on vertebral spinous processes.

Setting: Tertiary referring center

Patient: 44-year-old male from Kuwait.

Assessment/Results: Spine MRI showed abnormal signal throughout the axial skeleton, with soft tissue surrounding T4-6 vertebral bodies and extending into the right T4-5, T5-6 neural foramina. PET CT showed multiple osseous and soft tissue FDG intake. T-Spot test was positive. Sputum samples were negative of AFB. PET-CT guided left iliacus muscle biopsy culture grew M. tuberculosis. Patient was started on rifampin, isoniazid, pyrazinamide and ethambutol. Despite control of the infection, patient had persistent back pain, which was poorly controlled with gabapentin and celecoxib.

Discussion: Pott’s disease, an extra-pulmonary osteoarticular tuberculosis, is a rare condition in USA. In a 2017 CDC report, the annual incidence was 1:1,000,000. It causes destruction of the vertebral bodies. Back pain is very prevalent in these patients. MRI has the highest sensitivity and specificity and should be the first line of investigation. Culture of the infected tissue remains the gold standard for diagnosis. Management is mainly anti-tuberculosis chemotherapy. The pain usually improves with control of the infection. Intractable pain is a potential indication for surgery, to decompress and stabilize the spinal segments, and to drain abscess that failed conservative treatments. This patient’s pain remained poorly controlled and he eventually was referred to orthopedic surgery for decompression.

Conclusion: Pott’s disease is a rare cause of spinal pain. It is important to identify and treat it promptly to avoid a public health hazard. Pain usually improves with control of the infection. Intractable pain might warrant surgical decompression and stabilization.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/potts-disease-an-obsolete-but-serious-cause-of-back-pain/