Pott's Disease in Tuberculosis - Diagnosis and Management Summary

Epidemiology:

 - Typically from TB endemic areas

 - 1-5% of patients with TB

 - 10% of extrapulmonary cases

Clinical Signs/Symptoms:

 - Insidious, progressive back pain

 - Symptoms may range from a few months to several years

 - May have signs/symptoms of active pulmonary TB

PE: 

 - Local pain at thoracic/lumbar segment

 - "Gibbus deformity"

 - Assess for weakness, pain, numbness, decreased reflexes

Pathophysiology:

 - Mycobacterium tuberculosis complex

 - Spread of bacilli to bone/joints via hematogenous dissemination

Diagnosis:

 - MRI is modality of choice to visualize soft tissue damage

 - CXR should be done in ALL patients to assess for concomitant pulmonary involvement

 - CT guided needle aspiration or excisional biopsy

 - Detection of AFB by smear microscopy

Management:

 - Initial intensive RIPE therapy for 2 month

 - Continuation phase with Isoniazid and Rifampin for 4-7 months +/- Surgical intervention



CMC IM Residency @CMC_IM



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