Abstract Introduction Pott’s disease is a rare manifestation of extrapulmonary Tuberculosis (TB) involving the spine. Though most cases affect the thoracic and lumbar vertebrae, fewer than 10% occur in the cervical spine, posing risk for airway compromise and neurologic symptoms. Diagnosis is often delayed as symptoms are nonspecific and pulmonary testing typically negative. We present a case of cervical Pott’s disease with pharyngeal abscess causing airway and cord compromise. Case A 21-year-old male from West Africa with no medical history presented with 1.5 weeks of bilateral lower extremity weakness, mild upper-extremity weakness, and paresthesias. He reported decreased appetite and weight loss but denied fevers, chills, or recent illness. Three months prior, he had presented with chest pain that radiated to the neck; cardiac workup was unremarkable but incomplete, as the patient left before being seen. Social history included recent immigration to the U.S.; tuberculin skin test (PPD) at entry was negative. On examination, the patient was afebrile and hemodynamically stable. Laboratory studies showed hypercalcemia, elevated inflammatory markers and protein gap; HIV and hepatitis serologies were negative. Computed tomography of the cervical spine revealed a peripherally enhancing collection with bony destruction of C5-C6 disc space and C6 vertebral body and a partial narrowing of the hypopharynx. Magnetic resonance imaging (MRI) showed epidural enhancement with severe canal stenosis, cord edema from C4-C6, and a prevertebral abscess from C2-6. Bronchoscopy demonstrated no abnormalities; sputum and bronchoalveolar lavage acid-fast bacilli (AFB) smears were negative. Neurosurgery and otolaryngology performed a joint evacuation of the retropharyngeal and parapharyngeal abscesses with a C5-C6 corpectomy and fusion. Pathology showed necrotizing granulomatous inflammation and PCR testing positive for Mycobacterium tuberculosis. Treatment with rifampin, isoniazid + pyridoxine, pyrazinamide, and ethambutol for 11 months led to neurologic recovery and stable postoperative imaging. Discussion Cervical spine TB with abscess formation and airway involvement is exceedingly rare and can mimic malignancy or osteomyelitis. This case highlights diagnostic and management challenges in young, immunocompetent patients with negative PPDs and no pulmonary findings. Suspicion should be heightened when treating immigrant patients with high-risk exposures. Multidisciplinary management includes prompt and coordinated surgical decompression, airway vigilance, and antimicrobials to prevent irreversible neurologic sequelae. Conclusion Pott’s disease should remain in the differential diagnosis of destructive cervical spine lesions and subacute weakness, even in hemodynamically stable patients who have negative PPD tests. Early recognition and combined surgical and medical treatment can lead to full functional recovery. This abstract is funded by: None
Rahi et al. (Fri,) studied this question.