Pott’s Disease as the Initial Presentation of Tuberculosis: Diagnostic Challenges and Radiological Findings in District-Level Care

Pott’s Disease as the Initial Presentation of Tuberculosis: Diagnostic Challenges and Radiological Findings in District-Level Care | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Pott’s Disease as the Initial Presentation of Tuberculosis: Diagnostic Challenges and Radiological Findings in District-Level Care Mazibukwana Thalente This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6566425/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Spinal tuberculosis (Pott’s disease) is a rare form of extra-pulmonary TB, often presenting with non-specific symptoms and posing diagnostic challenges, especially in resource-limited settings. While microbiological confirmation is the gold standard, it is often unavailable in district hospitals. Case presentation : We report the case of a previously healthy 28-year-old female who presented with a three-week history of progressive lower back pain, fatigue, and functional impairment, but without pulmonary symptoms or known TB contacts. Examination revealed a lumbar spinal bulge, localised kyphosis, and tenderness. Laboratory studies showed elevated inflammatory markers (CRP 157 mg/L, WCC 11.2 × 10⁹/L). Lumbar spine X-ray showed a wedge-shaped compression fracture at L3 with focal kyphotic deformity. Microbiological confirmation was not possible due to lack of advanced diagnostic facilities. After multidisciplinary consultation, empirical anti-tuberculous therapy was started. Conclusion This case illustrates the diagnostic complexity of spinal TB in resource-limited settings and underscores the value of clinical suspicion, multidisciplinary collaboration, and careful radiological assessment when advanced diagnostics are unavailable. Spinal TB should be considered in patients with chronic back pain and vertebral changes, even in the absence of classic TB symptoms. Early recognition and treatment are critical to prevent complications. Orthopedics Spinal tuberculosis Pott’s disease case report resource-limited empirical therapy diagnostic challenges kyphosis Figures Figure 1 Introduction Tuberculosis (TB) remains a major global health challenge, with extra-pulmonary forms accounting for an increasing proportion of cases, particularly in high TB-burden regions [ 1 ]. Spinal tuberculosis (Pott’s disease) makes up 1–2% of all TB cases and up to 50% of musculoskeletal TB [ 2 ]. Delayed diagnosis is common due to its insidious onset, non-specific symptoms, and frequent lack of access to advanced imaging or microbiological confirmation in resource-limited settings [ 3 ]. We present a case of Pott’s disease in a young woman, highlighting the diagnostic challenges and the need for clinical acumen in district-level care, where only plain radiography and basic labs are available. The case is notable for the absence of pulmonary symptoms, lack of TB contact, and the necessity of empirical therapy in the absence of definitive diagnostic modalities. Case Presentation A 28-year-old woman with no significant past medical history presented to the district hospital with a three-week history of progressive fatigue, lower back pain, inability to bend, and increasing reliance on a walking stick. She denied cough, shortness of breath, night sweats, fever, or weight loss, and there was no history of TB contact or immunosuppression. Her past medical history included a previous episode of back pain one year earlier, for which spinal X-rays were normal and symptomatic treatment was provided. HIV testing was negative. Ten months prior to this presentation, she developed a painless bulge on her lower back that gradually increased in size and became painful. On examination : Vital signs: Blood pressure 107/72 mmHg, pulse 133 bpm, temperature 36.5°C, SpO₂ 98% (room air). General : Mild conjunctival pallor, proteinuria (2+); no jaundice, cyanosis, clubbing, oedema, or lymphadenopathy. Well-nourished and hydrated. Neurological : Unremarkable except for leg shaking after prolonged walking, without sensory or motor deficits. Musculoskeletal : Visible and palpable bulge at L2–L4 with local tenderness and pain radiating to the thigh. Focal kyphosis seen in the lumbar region. Other systems : Respiratory, cardiovascular, and abdominal examinations were unremarkable. Laboratory results : Sodium: 135 mmol/L Potassium: 4.1 mmol/L C-reactive protein (CRP): 157 mg/L (elevated) White cell count (WCC): 11.2 × 10⁹/L (mildly raised) Haemoglobin: 10.9 g/dL (mild anaemia) Platelets: 432 × 10⁹/L (thrombocytopenia) Urinalysis: proteinuria (2+) Radiological findings: Lumbar spine X-ray (Figure 1): The lateral view showed a severe wedge-shaped compression fracture of the L3 vertebral body, with marked reduction in vertebral height and loss of the anterior cortex. There was associated collapse of the L3–L4 disc space, abnormal alignment with focal kyphosis entered at the affected level, and irregularity of adjacent vertebral endplates (L2 and L4), suggestive of extension of the disease process. No paraspinal abscess was visible on the plain film, but the degree of vertebral destruction and deformity was highly suggestive of advanced tuberculous spondylodiscitis (Pott’s disease) in the appropriate clinical context. Microbiological confirmation (e.g., sputum, tissue biopsy) was not possible due to absence of pulmonary symptoms and lack of access to advanced diagnostic facilities (no MRI or CT, no image-guided biopsy). Differential diagnosis: Neoplastic disease (primary bone tumour or metastasis) Pyogenic spondylodiscitis Osteoporotic fracture (unlikely due to age and lack of risk factors) Spinal tuberculosis (favoured by endemic area, chronicity, and radiological findings) Given the clinical and radiological features, and after multidisciplinary discussion with a TB spine specialist at a tertiary centre, a diagnosis of spinal TB (Pott’s disease) with radiculopathy and kyphosis was made. Empirical anti-tuberculous therapy was commenced according to national guidelines. The patient was transferred for further evaluation and potential advanced imaging and surgical assessment. Outcome: At two-week follow-up, the patient reported improvement in pain and mobility. Long-term follow-up and advanced imaging at a tertiary centre were planned. Discussion Spinal TB is the most common form of skeletal tuberculosis, predominantly affecting the thoracic and lumbar vertebrae [2,4]. Its presentation is typically insidious, with localised back pain as the most frequent symptom. Constitutional features such as fever, night sweats, and weight loss may be absent, as in this case [5]. Neurological deficits are reported in up to 50% of cases but may be absent in early disease, resulting in diagnostic delays [6]. In resource-limited settings, diagnosis relies heavily on clinical judgment, as advanced imaging (MRI, CT) and bacteriological confirmation are often unavailable [3]. Plain X-rays may only reveal late changes such as vertebral collapse or kyphotic deformity [7]. In this patient, the combination of chronic back pain, local swelling, focal kyphosis, elevated inflammatory markers, and wedge-compression fracture on X-ray was highly suggestive of Pott’s disease. The novelty of this case lies in the necessity to make a diagnosis and initiate potentially life-saving therapy based on clinical and basic radiological findings alone, in the absence of microbiological confirmation or advanced imaging—a scenario common in district-level hospitals in high-prevalence regions but underrepresented in the medical literature. This case demonstrates the importance of maintaining a high index of suspicion and consulting with sub-specialists even in low-resource settings. Empirical anti-TB therapy is often justified in high-prevalence settings when suspicion is high, given the risk of irreversible neurological damage if treatment is delayed [8]. However, this approach carries risks, including over-treatment and missed alternative diagnoses. In this case, the chronicity, endemic context, and radiological findings supported spinal TB as the most likely diagnosis. Limitations : Microbiological confirmation and advanced imaging were unavailable. Empirical treatment carries a risk of mistreatment if the diagnosis is incorrect. Short-term follow-up only; long-term outcome pending tertiary evaluation. Recommendations for Practitioners: In resource-limited, high-prevalence areas, clinicians should consider spinal TB in patients with chronic back pain and vertebral changes, even in the absence of classic symptoms or risk factors. Early referral to a multidisciplinary team and sub-specialist consultation are essential. National TB guidelines should be followed for empirical treatment when appropriate. All cases should be followed up for confirmation and assessment at higher-level facilities where possible. Conclusion This case highlights the diagnostic challenges of extra-pulmonary TB in resource-limited, district-level settings. Clinical acumen, multidisciplinary collaboration, and initiation of empirical therapy where appropriate, are essential to prevent complications and improve patient outcomes. Learning Points Spinal TB should be considered in patients with chronic back pain, vertebral abnormalities, and spinal deformity (kyphosis), particularly in TB-endemic areas, even without pulmonary symptoms. Diagnosis in resource-limited settings may require empirical anti-tuberculous therapy based on clinical and radiological findings alone when advanced diagnostics are unavailable. Multidisciplinary input, including sub-specialist consultation and prompt referral to higher-level care, is crucial for optimal management. Patient Perspective "At first, I thought my back pain would go away on its own, but when I started struggling to walk and noticed the swelling, I became worried. The doctors explained that I might have TB in my spine, which surprised me since I didn’t have a cough or fever. I am grateful for the treatment, and within a few weeks I could walk more comfortably. I am hopeful for a full recovery." Patient Consent Written informed consent was obtained from the patient for publication of this case report and accompanying details. References World Health Organization (2023) Global tuberculosis report 2023. WHO, Geneva Garg RK, Somvanshi DS (2011) Spinal tuberculosis: A review. J Spinal Cord Med 34(5):440–454 Turgut M (2001) Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 24(1):8–13 Jain AK (2010) Tuberculosis of the spine: A fresh look at an old disease. J Bone Joint Surg Br 92(7):905–913 Moon MS (2014) Tuberculosis of the spine: current views in diagnosis and management. Asian Spine J 8(1):97–111 Rajasekaran S, Soundararajan DCR, Shetty AP, Kanna RM (2018) Spinal tuberculosis: current concepts. Global Spine J 8(4suppl):96S–108S Dunn RN, Ben Husien M (2018) Spinal tuberculosis: review of current management. Bone Joint J 100–B(4):425–431 Kim JH, Kim SH, Choi JI, Lim DJ, Lee IW, Kim HJ et al (2017) Outcome and management of tuberculous spondylitis according to the involvement of the vertebral column. J Korean Neurosurg Soc 60(3):357–363. 10.3340/jkns.2017.0101.002 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6566425","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":450317659,"identity":"9e59b876-5d2a-45e5-9d3d-b3c1066cf09c","order_by":0,"name":"Mazibukwana Thalente","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIie3PMW7CMBSAYVtPcpbXZgV56BUcZaqaioGLOEJKlzL0BE1lySy0WWHqLZiJfABWJC8gLhDEErUMNWwsDt0q1f/w5MGfnk1IKPQng9KN7FUDmE3jjizqAEioI7KgVcSKZHYicB0xdF6h4Hhe20EGUf22e2kNCENEmn0t7m6B0Gb/7NmCuUpn8ok5InfjD5toINCfL3wPyzVH+YCOLNPx1FJHGNz4SLydfKOEnjC05PdTO+gmvVwDyqHoKyCctDbvJuut4lgUMgbGkvfSjjRQ5f1LVI3qA2aZZPHqsGmP9vFzoupm7yGXUX2e5bX3Tx1/czkUCoX+Sz+voUu9B/rbGgAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0000-2010-1966","institution":"Oliver and Adelaide Tambo Regional Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mazibukwana","middleName":"","lastName":"Thalente","suffix":""}],"badges":[],"createdAt":"2025-04-30 15:41:33","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6566425/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6566425/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81955470,"identity":"a8a98fe1-e1cd-48c9-bff6-f798b189e12d","added_by":"auto","created_at":"2025-05-05 09:51:25","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":800266,"visible":true,"origin":"","legend":"\u003cp\u003eLumbar X ray\u003c/p\u003e","description":"","filename":"IMG1780.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6566425/v1/4e5caea6e7f051fa9fa22edf.jpg"},{"id":81955471,"identity":"8f5aff7d-d2ed-4229-ab81-18a7d165c776","added_by":"auto","created_at":"2025-05-05 09:51:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1151518,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6566425/v1/d1ffefb9-3bd2-4f5b-8521-34beabc621c8.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003ePott’s Disease as the Initial Presentation of Tuberculosis: Diagnostic Challenges and Radiological Findings in District-Level Care\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTuberculosis (TB) remains a major global health challenge, with extra-pulmonary forms accounting for an increasing proportion of cases, particularly in high TB-burden regions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Spinal tuberculosis (Pott\u0026rsquo;s disease) makes up 1\u0026ndash;2% of all TB cases and up to 50% of musculoskeletal TB [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Delayed diagnosis is common due to its insidious onset, non-specific symptoms, and frequent lack of access to advanced imaging or microbiological confirmation in resource-limited settings [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. We present a case of Pott\u0026rsquo;s disease in a young woman, highlighting the diagnostic challenges and the need for clinical acumen in district-level care, where only plain radiography and basic labs are available. The case is notable for the absence of pulmonary symptoms, lack of TB contact, and the necessity of empirical therapy in the absence of definitive diagnostic modalities.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 28-year-old woman with no significant past medical history presented to the district hospital with a three-week history of progressive fatigue, lower back pain, inability to bend, and increasing reliance on a walking stick. She denied cough, shortness of breath, night sweats, fever, or weight loss, and there was no history of TB contact or immunosuppression.\u003c/p\u003e\n\u003cp\u003eHer past medical history included a previous episode of back pain one year earlier, for which spinal X-rays were normal and symptomatic treatment was provided. HIV testing was negative. Ten months prior to this presentation, she developed a painless bulge on her lower back that gradually increased in size and became painful.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOn examination\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eVital signs:\u0026nbsp;\u003c/u\u003e Blood pressure 107/72 mmHg, pulse 133 bpm, temperature 36.5°C, SpO₂ 98% (room air).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eGeneral\u003c/u\u003e: Mild conjunctival pallor, proteinuria (2+); no jaundice, cyanosis, clubbing, oedema, or lymphadenopathy. Well-nourished and hydrated.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eNeurological\u003c/u\u003e: \u0026nbsp;Unremarkable except for leg shaking after prolonged walking, without sensory or motor deficits.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMusculoskeletal\u003c/u\u003e: \u0026nbsp;Visible and palpable bulge at L2–L4 with local tenderness and pain radiating to the thigh. Focal kyphosis seen in the lumbar region.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eOther systems\u003c/u\u003e: Respiratory, cardiovascular, and abdominal examinations were unremarkable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory results\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eSodium: 135 mmol/L\u003c/p\u003e\n\u003cp\u003ePotassium: 4.1 mmol/L\u003c/p\u003e\n\u003cp\u003eC-reactive protein (CRP): 157 mg/L (elevated)\u003c/p\u003e\n\u003cp\u003eWhite cell count (WCC): 11.2 × 10⁹/L (mildly raised)\u003c/p\u003e\n\u003cp\u003eHaemoglobin: 10.9 g/dL (mild anaemia)\u003c/p\u003e\n\u003cp\u003ePlatelets: 432 × 10⁹/L (thrombocytopenia)\u003c/p\u003e\n\u003cp\u003eUrinalysis: proteinuria (2+)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRadiological findings:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLumbar spine X-ray (Figure 1):\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe lateral view showed a severe wedge-shaped compression fracture of the L3 vertebral body, with marked reduction in vertebral height and loss of the anterior cortex. There was associated collapse of the L3–L4 disc space, abnormal alignment with focal kyphosis entered at the affected level, and irregularity of adjacent vertebral endplates (L2 and L4), suggestive of extension of the disease process. No paraspinal abscess was visible on the plain film, but the degree of vertebral destruction and deformity was highly suggestive of advanced tuberculous spondylodiscitis (Pott’s disease) in the appropriate clinical context.\u003c/p\u003e\n\u003cp\u003eMicrobiological confirmation (e.g., sputum, tissue biopsy) was not possible due to absence of pulmonary symptoms and lack of access to advanced diagnostic facilities (no MRI or CT, no image-guided biopsy).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDifferential diagnosis:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eNeoplastic disease (primary bone tumour or metastasis)\u003c/li\u003e\n \u003cli\u003ePyogenic spondylodiscitis\u003c/li\u003e\n \u003cli\u003eOsteoporotic fracture (unlikely due to age and lack of risk factors)\u003c/li\u003e\n \u003cli\u003eSpinal tuberculosis (favoured by endemic area, chronicity, and radiological findings)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eGiven the clinical and radiological features, and after multidisciplinary discussion with a TB spine specialist at a tertiary centre, a diagnosis of spinal TB (Pott’s disease) with radiculopathy and kyphosis was made. Empirical anti-tuberculous therapy was commenced according to national guidelines. The patient was transferred for further evaluation and potential advanced imaging and surgical assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt two-week follow-up, the patient reported improvement in pain and mobility. Long-term follow-up and advanced imaging at a tertiary centre were planned.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSpinal TB is the most common form of skeletal tuberculosis, predominantly affecting the thoracic and lumbar vertebrae [2,4]. Its presentation is typically insidious, with localised back pain as the most frequent symptom. Constitutional features such as fever, night sweats, and weight loss may be absent, as in this case [5]. Neurological deficits are reported in up to 50% of cases but may be absent in early disease, resulting in diagnostic delays [6].\u003c/p\u003e\n\u003cp\u003eIn resource-limited settings, diagnosis relies heavily on clinical judgment, as advanced imaging (MRI, CT) and bacteriological confirmation are often unavailable [3]. Plain X-rays may only reveal late changes such as vertebral collapse or kyphotic deformity [7]. In this patient, the combination of chronic back pain, local swelling, focal kyphosis, elevated inflammatory markers, and wedge-compression fracture on X-ray was highly suggestive of Pott’s disease.\u003c/p\u003e\n\u003cp\u003eThe novelty of this case lies in the necessity to make a diagnosis and initiate potentially life-saving therapy based on clinical and basic radiological findings alone, in the absence of microbiological confirmation or advanced imaging—a scenario common in district-level hospitals in high-prevalence regions but underrepresented in the medical literature. This case demonstrates the importance of maintaining a high index of suspicion and consulting with sub-specialists even in low-resource settings.\u003c/p\u003e\n\u003cp\u003eEmpirical anti-TB therapy is often justified in high-prevalence settings when suspicion is high, given the risk of irreversible neurological damage if treatment is delayed [8]. However, this approach carries risks, including over-treatment and missed alternative diagnoses. In this case, the chronicity, endemic context, and radiological findings supported spinal TB as the most likely diagnosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eMicrobiological confirmation and advanced imaging were unavailable.\u003c/li\u003e\n \u003cli\u003eEmpirical treatment carries a risk of mistreatment if the diagnosis is incorrect.\u003c/li\u003e\n \u003cli\u003eShort-term follow-up only; long-term outcome pending tertiary evaluation.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations for Practitioners:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eIn resource-limited, high-prevalence areas, clinicians should consider spinal TB in patients with chronic back pain and vertebral changes, even in the absence of classic symptoms or risk factors.\u003c/li\u003e\n \u003cli\u003eEarly referral to a multidisciplinary team and sub-specialist consultation are essential.\u003c/li\u003e\n \u003cli\u003eNational TB guidelines should be followed for empirical treatment when appropriate.\u003c/li\u003e\n \u003cli\u003eAll cases should be followed up for confirmation and assessment at higher-level facilities where possible.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case highlights the diagnostic challenges of extra-pulmonary TB in resource-limited, district-level settings. Clinical acumen, multidisciplinary collaboration, and initiation of empirical therapy where appropriate, are essential to prevent complications and improve patient outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLearning Points\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eSpinal TB should be considered in patients with chronic back pain, vertebral abnormalities, and spinal deformity (kyphosis), particularly in TB-endemic areas, even without pulmonary symptoms.\u003c/li\u003e\n \u003cli\u003eDiagnosis in resource-limited settings may require empirical anti-tuberculous therapy based on clinical and radiological findings alone when advanced diagnostics are unavailable.\u003c/li\u003e\n \u003cli\u003eMultidisciplinary input, including sub-specialist consultation and prompt referral to higher-level care, is crucial for optimal management.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003ePatient Perspective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"At first, I thought my back pain would go away on its own, but when I started struggling to walk and noticed the swelling, I became worried. The doctors explained that I might have TB in my spine, which surprised me since I didn’t have a cough or fever. I am grateful for the treatment, and within a few weeks I could walk more comfortably. I am hopeful for a full recovery.\"\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and accompanying details.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2023) Global tuberculosis report 2023. WHO, Geneva\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarg RK, Somvanshi DS (2011) Spinal tuberculosis: A review. J Spinal Cord Med 34(5):440\u0026ndash;454\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurgut M (2001) Spinal tuberculosis (Pott\u0026rsquo;s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 24(1):8\u0026ndash;13\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain AK (2010) Tuberculosis of the spine: A fresh look at an old disease. J Bone Joint Surg Br 92(7):905\u0026ndash;913\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoon MS (2014) Tuberculosis of the spine: current views in diagnosis and management. Asian Spine J 8(1):97\u0026ndash;111\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRajasekaran S, Soundararajan DCR, Shetty AP, Kanna RM (2018) Spinal tuberculosis: current concepts. Global Spine J 8(4suppl):96S\u0026ndash;108S\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDunn RN, Ben Husien M (2018) Spinal tuberculosis: review of current management. Bone Joint J 100\u0026ndash;B(4):425\u0026ndash;431\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim JH, Kim SH, Choi JI, Lim DJ, Lee IW, Kim HJ et al (2017) Outcome and management of tuberculous spondylitis according to the involvement of the vertebral column. J Korean Neurosurg Soc 60(3):357\u0026ndash;363. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3340/jkns.2017.0101.002\u003c/span\u003e\u003cspan address=\"10.3340/jkns.2017.0101.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Oliver and Adelaide Tambo Regional Hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Spinal tuberculosis, Pott’s disease, case report, resource-limited, empirical therapy, diagnostic challenges, kyphosis","lastPublishedDoi":"10.21203/rs.3.rs-6566425/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6566425/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSpinal tuberculosis (Pott\u0026rsquo;s disease) is a rare form of extra-pulmonary TB, often presenting with non-specific symptoms and posing diagnostic challenges, especially in resource-limited settings. While microbiological confirmation is the gold standard, it is often unavailable in district hospitals.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e \u003cp\u003e: We report the case of a previously healthy 28-year-old female who presented with a three-week history of progressive lower back pain, fatigue, and functional impairment, but without pulmonary symptoms or known TB contacts. Examination revealed a lumbar spinal bulge, localised kyphosis, and tenderness. Laboratory studies showed elevated inflammatory markers (CRP 157 mg/L, WCC 11.2 \u0026times; 10⁹/L). Lumbar spine X-ray showed a wedge-shaped compression fracture at L3 with focal kyphotic deformity. Microbiological confirmation was not possible due to lack of advanced diagnostic facilities. After multidisciplinary consultation, empirical anti-tuberculous therapy was started.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis case illustrates the diagnostic complexity of spinal TB in resource-limited settings and underscores the value of clinical suspicion, multidisciplinary collaboration, and careful radiological assessment when advanced diagnostics are unavailable. Spinal TB should be considered in patients with chronic back pain and vertebral changes, even in the absence of classic TB symptoms. Early recognition and treatment are critical to prevent complications.\u003c/p\u003e","manuscriptTitle":"Pott’s Disease as the Initial Presentation of Tuberculosis: Diagnostic Challenges and Radiological Findings in District-Level Care","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 09:43:20","doi":"10.21203/rs.3.rs-6566425/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dea7d98a-3be6-409a-b252-e89257d12efd","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47920154,"name":"Orthopedics"}],"tags":[],"updatedAt":"2025-05-05T09:43:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 09:43:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6566425","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6566425","identity":"rs-6566425","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}