Tuberculous Spondylodiscitis: A Case Report

Pott’s disease, or tuberculous spondylitis, is a form of extrapulmonary tuberculosis that affects intervertebral discs and adjacent vertebral bodies and can lead to severe complications such as bone deformities and abscesses, including the atypical psoas muscle abscess. Risk groups include immunosuppressed individuals, travelers, and residents of endemic areas, with predominance in men in the fifth to seventh decades of life. This report aims to describe an atypical case of tuberculous spondylodiscitis associated with a psoas muscle abscess in a patient without immunosuppression or comorbidities, highlighting it as a relevant differential diagnosis for low back pain. Materials and methods: Medical record review, team discussion, and literature review. Results: A 40-year-old male was hospitalized due to chronic lumbosacral pain and 10 kg weight loss. He denied comorbidities and drug use, except for a 15-year smoking history that he had recently quit. There was no known contact with TB cases. During hospitalization, CT of the lumbosacral spine showed a fluid collection in the left iliopsoas muscle region, and MRI suggested acute spondylodiscitis at T12–L1 associated with a left iliopsoas abscess, fractures and erosions of the respective vertebral bodies, and adjacent edema. Surgical drainage and sampling were performed; GeneXpert and culture were positive for Mycobacterium tuberculosis, and bacterial culture was negative. Treatment with rifampicin, isoniazid, pyrazinamide, and ethambutol (RHZE) was started. The patient improved, with reduced pain, good adherence, and outpatient follow-up with infectious diseases and the municipal TB service. Conclusion: This case emphasizes tuberculosis as a differential diagnosis for chronic low back pain, even in immunocompetent individuals, particularly when systemic infection signs or deep abscesses are present. Early use of high-sensitivity imaging such as MRI, combined with rapid and specific microbiological methods like GeneXpert, is essential for definitive diagnosis and timely intervention to ensure therapeutic success. This report reinforces the need for multidisciplinary clinical vigilance in atypical manifestations of extrapulmonary TB.