Intrathoracic Vertebral Allograft Migration After Surgery for Pediatric Pott Disease: A Case Report With Radiologic-Pathologic Correlation and a Critical Diagnostic Review

Pediatric Pott disease can require debridement, corpectomy, and anterior column reconstruction when vertebral destruction, instability, deformity, or neurologic risk is present. Years later, postoperative structural sequelae may overlap clinically and radiologically with suspected recurrent thoracic tuberculosis. We report the case of a six-year-old girl with thoracic vertebral tuberculosis diagnosed in 2021, supported by immunologic, molecular, and histopathologic evidence, including vertebral granulomatous inflammation with acid-fast bacilli. She underwent right posterolateral thoracotomy, thoracic corpectomy centered at T4, and reconstruction with an approximately 2-cm fibular structural allograft, followed by completion of antituberculous therapy. In 2025, she presented with fever, persistent cough, recurrent respiratory episodes, weight loss, severe malnutrition, calcified mediastinal findings, extrinsic airway compression, and intrathoracic bone-density material adjacent to the prior reconstruction, raising concern for pulmonary reinfection or pleural tuberculosis. GeneXpert, acid-fast bacilli smears, cultures, and mycobacterial polymerase chain reaction testing were negative or non-confirmatory, and no safe percutaneous biopsy window was documented. Diagnostic right posterolateral thoracotomy demonstrated pleuropulmonary adhesions and material compatible with a migrated fibular allograft, without abnormal thoracic or hilar lymph nodes. Right pleural histopathology showed fibrosing pleuritis without granulomas, caseous necrosis, active inflammation, acid-fast bacilli, or malignancy. Empirical antituberculous retreatment was not restarted. This case, accompanied by a focused critical diagnostic review, emphasizes multimodal correlation to differentiate active tuberculous relapse from postoperative structural mimics.