A 27-Year-Old Woman Diagnosed with Tuberculous Spondylitis, or Pott Disease, During Pregnancy: A Case Report

Patient: Female, 27-year-old Final Diagnosis: Pott’s disease Symptoms: Worsening severe neck and back pain Medication: Anti-tuberculosis medications Clinical Procedure: Post-gadolinium contrast T1-weighted diffusion magnetic resonance imaging (MRI) demonstrated multiple soft tissue spinal lesion (T2-T4) • computed tomography (CT)-guided biopsy confirmed a case of Pott’s disease Specialty: Obstetrics and Gynecology OBJECTIVE: Rare disease BACKGROUND: Tuberculous spondylitis, or Pott disease, includes vertebral body osteomyelitis and intervertebral discitis following infection with Mycobacterium tuberculosis and can present with vertebral collapse and back pain. This report is of a 27-year-old woman diagnosed with tuberculous spondylitis, or Pott disease, during pregnancy. CASE REPORT: A 27-year-old female, in her first pregnancy and at 29 weeks of gestation, presented to the Emergency Department with worsening severe neck and back pain for the past 5 months. Post-gadolinium contrast T1-weighted diffusion magnetic resonance imaging demonstrated multiple soft tissue spinal lesions (T2-T4). Computed tomography-guided biopsy showed a central caseous necrosis enclosed by a granuloma containing a wide array of cells comprising epithelioid cells, Langhans giant cells, lymphocytes, and plasma cells. Ziehl-Neelsen staining was positive for acid-fast bacilli. The final diagnosis was consistent with Pott disease. The patient received anti-tuberculosis medications, her symptoms improved over time, and she delivered vaginally at term. At a 16-month follow-up, her symptoms had improved, and she returned to her normal daily activities. There were no complications arising from the use of gadolinium contrast in the mother or toddler. CONCLUSIONS: This report has highlighted the importance of imaging of the spine in the diagnosis of causes of severe back pain. This rare presentation of Pott disease in pregnancy has shown the challenges in diagnosis and the importance of a multidisciplinary approach to diagnosis and management so that treatment protects both the mother and fetus.