Abstracto

30-year-old man with low back pain, fever, and weight loss.Imaging revealed spondylodiscitis, confirmed by biopsyand molecular testing for tuberculosis. Early diagnosis oftuberculous spondylodiscitis is essential to prevent vertebral collapse, spinal deformities, and neurologic deficits.

CLINICAL HISTORY

A 30-year-old previously healthy man presented with progressive low back pain, intermittent fever, weight loss, and difficulty walking. He denied respiratory symptoms.

 

IMAGING FINDINGS

X-ray (Fig. 01) showed vertebral erosions at L2-L3 and loss of the left psoas outline. CT (Fig. 02) demonstrated lytic lesions in the L2-L3 endplates and paravertebral soft tissue thickening.MRI (Fig. 03) revealed low T1 and high T2 signal in the L2-L3vertebrae, post-contrast enhancement of endplates and softtissues, and a left paravertebral abscess extending into thepsoas. Chest CT (Fig.04) additionally showed consolidation in the left upper lobe despite negative sputum smears.

 

DISCUSSION

Spinal tuberculosis (Pott’s disease) remains an important cause of infectious spondylodiscitis in endemic regions[1]. It usually presents insidiously with nonspecific symptoms such as back pain, fever, and weight loss. The absence of pulmonary signs or positive sputum smears, as in this case, may delay diagnosis[2,3]. Acharya et al. (2024) emphasize that the combination of imaging-especially MRI and CT-with CT-guided biopsy remains the most effective and early approach for definitive diagnosis. Histopathology provides the fastest confirmation, while NAAT and culture often show low initial positivity [4].Imaging plays a central role: MRI is the most sensitive modality for early detection of marrow edema, abscesses, and soft tissue extension [2,3], while CT highlights bone destruction and is useful for guiding biopsies [2,3]. X-ray usually demonstrates more advanced changes such as vertebral collapse or obscuration of the psoas margin [2]. Typical features of spinal TB include anterior vertebral body involvement, relative disc sparing in early stages, multilevel spread, and the formation of large paravertebral abscesses with central necrosis and thin walls [2,3]. This contrasts with pyogenic spondylodiscitis, usually due to Staphylococcus aureus, which has an abrupt onset, early disc involvement, and more compact abscesses [3]. In our patient, biomechanical instability and early deformity indicated the need for surgical stabilization in addition to antitubercular therapy [2]. The goals of surgery include radical debridement, neural decompression, deformity correction, and spinal stabilization. Recent reviews highlight the growing trend toward minimizing surgical morbidity while maintaining effectiveness[5]. If untreated, spinal TB may progress to vertebral collapse, kyphotic deformity, spinal cord compression, and neurological deficits such as radiculopathy or paraplegia[2].

 

DIFFERENTIAL DIAGNOSIS

• Pyogenic spondylodiscitis;

• Vertebral metastasis;

• Retroperitoneal sarcoma;

• Lymphoma;

• Brucellosis;

• Actinomycosis.

 

TEACHING POINTS

Spinal tuberculosis may present subtly, without pulmonary signs. In such situations, imaging and CT-guided biopsy with histopathology are indispensable for early and accurate diagnosis, guiding prompt therapy and preventing severe complications.

 

REFERENCES

1. Chakaya J, et al. Global Tuberculosis Report 2023: update on TB burden, diagnosis and treatment. Lancet Infect Dis. 2023;23(10):1103-1116.

2. Moon MS. Tuberculosis of the spine: current views in diagnosis and management. Asian Spine J. 2020;14(6):967-983.

3. Zuluaga AF, et al. Diagnosis and treatment of spinal tuberculosis: a review of recent literature. Curr Rheumatol Rep. 2019;21(11):58.

4. Acharya A, et al. Spinal Tuberculosis: An Exhaustive Diagnosis. Int J Mycobacteriol. 2024;13(1):65-71.

5. Gan J, et al. Surgical treatment of spinal tuberculosis: an updated review. Eur J Med Res. 2024;29(1):77.

 

 

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Artículo recibido en martes, 29 de julio de 2025

Artículo aceptado el domingo, 22 de febrero de 2026