Unusual co-presentation of cervical lordosis reversal and bilateral psoas abscess in a paediatric patient with spinal tuberculosis

Spinal tuberculosis in children is uncommon and often presents with nonspecific symptoms, leading to delayed diagnosis and increased risk of complications. We report a rare and severe presentation of spinal tuberculosis in a 16-year-old female with simultaneous pulmonary tuberculosis, extensive lumbar vertebral involvement, bilateral psoas abscesses, and loss of cervical lordosis. The patient presented with progressive lower limb weakness, severe back pain, and chronic cough. Imaging revealed destructive changes involving the L2–L3 vertebrae with epidural collection and bilateral psoas abscesses, along with loss of the normal cervical curvature suggestive of inflammatory or muscle spasm–related alignment disturbance. The clinical course was further complicated by severe anemia, electrolyte imbalance, and episodes of bradycardia requiring intensive care. Anti-tubercular therapy was initiated as per national guidelines, along with supportive management and physiotherapy. The patient showed gradual clinical improvement with stabilization of neurological function. This case highlights the importance of early imaging, high clinical suspicion, and multidisciplinary management in pediatric spinal tuberculosis, particularly when rare and multifocal manifestations are present, to prevent long-term morbidity and spinal deformity.