Swiss Cheese Loin: A Rare Initial Presentation of Pott’s Spine

Spinal tuberculosis (TB) is the most common form of skeletal TB with an exceedingly diverse set of clinical presentations. Most often, there is a slow onset of the disease with patients presenting only with back pain. Although some patients can present later with neurological deficits or with compressive symptoms of an accompanying cold abscess, an initial presentation of a spontaneous cutaneous fistulization of a paraspinal abscess is rare. We present the case of a young boy with such a primary presentation, with no other common symptoms of spinal TB. He was treated with ultrasound-guided percutaneous drainage of the paraspinal abscess and a multidrug anti-tubercular chemotherapy regimen.