Pott's disease presenting with bilateral psoas abscesses in a resource-poor setting: Case report and literature review

Abstract

INTRODUCTION AND IMPORTANCE: Tuberculosis (TB) primarily affects the lungs, but can cause extrapulmonary TB (EPTB), including spinal TB (Pott's disease), which presents with variable symptoms. Tuberculous psoas abscesses, a complication of Pott's disease, are increasingly reported due to improved diagnostics. CASE PRESENTATION: A 32-year-old male from the Somalia region of Ethiopia presented with a history of chronic lower back pain that had worsened over the preceding month, with lower back swelling, unquantified weight loss, and a slight limp. He also reported intermittent, mild lower quadrant abdominal pain. Physical examination revealed a chronically ill with stable vital sign. A 7 × 5 cm soft tissue swelling, localized to the lumbar area. Due to late presentation and the lack of advanced imaging capabilities such as CT scans at our facility, the diagnostic process was challenging. Spinal swelling was noted, and after incision and drainage, the discharge was analyzed using GeneXpert and Mycobacterium tuberculosis was detected by GeneXpert confirming a diagnosis of spinal tuberculosis, and an abdominal ultrasound showed a psoas abscess. The patient was started on anti-TB therapy and is improving, CASE DISCUSSION: Tuberculous psoas abscess, a known complication of Pott's disease (spinal tuberculosis), is relatively uncommon, occurring in about 5 % of cases despite modern anti-TB treatment. Psoas abscesses can arise primarily or secondarily, the latter resulting from TB spread from nearby structures, as seen in our patient. Diagnosis of psoas abscess and spinal TB typically necessitates advanced imaging, which is currently unavailable in our setting. Timely management is crucial for improved patient outcomes. Management involves prolonged anti-TB therapy with pyridoxine supplementation and surgical intervention for neurological complications. Most patients respond well to this approach. CONCLUSION: Psoas TB abscess, while rare, poses a significant clinical challenge, particularly in resource-limited settings due to the patient's late presentation and the limited availability of advanced imaging, such as CT scans. Timely diagnosis, appropriate anti-tuberculosis therapy, and, when necessary, surgical interventions are crucial for optimizing patient outcomes.