Unusual Co-Presentation of Cervical Lordosis Reversal and Bilateral Psoas Abscess in a Pediatric Patient with Spinal Tuberculosis

Unusual Co-Presentation of Cervical Lordosis Reversal and Bilateral Psoas Abscess in a Pediatric Patient with Spinal Tuberculosis | 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 Unusual Co-Presentation of Cervical Lordosis Reversal and Bilateral Psoas Abscess in a Pediatric Patient with Spinal Tuberculosis Diksha Chandwani, Hari Shankar, Jaya Sharma, Yoshita Gupta, Rajveer Singh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8172665/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 in children is uncommon and often remains undiagnosed due to vague symptoms. The coexistence of cervical lordosis reversal and bilateral psoas abscess is extremely rare and indicates advanced systemic disease. Early recognition is vital to prevent neurological impairment and spinal deformity. CASE PRESENTATION A 16-year-old female presented with progressive lower limb weakness, severe back pain, and chronic cough. Imaging revealed Pott’s disease affecting L2–L3 vertebrae, bilateral psoas abscesses, and reversal of cervical lordosis. She also had pulmonary tuberculosis, severe anemia, electrolyte imbalance, and developed bradycardia requiring ICU care. MRI confirmed vertebral destruction and epidural collection. Anti-tubercular therapy was initiated based on ICMR guidelines along with supportive management. CONCLUSION This rare presentation highlights the importance of prompt imaging, early suspicion, and multidisciplinary management in pediatric spinal tuberculosis. Cervical lordosis reversal with psoas abscess signifies severe disease progression. Timely anti-tubercular treatment and supportive care can prevent long-term disability and improve recovery. The patient achieved near-complete recovery with anti-tubercular therapy and supportive care. Spinal Tuberculosis Pott’s Disease Pulmonary Tuberculosis Psoas Abscess Figures Figure 1 Figure 2 INTRODUCTION Cervical lordosis refers to the normal inward curvature of the neck region of the spine, which is essential for maintaining head balance, posture, and overall spinal alignment. Pott’s disease, also known as spinal tuberculosis, is caused by Mycobacterium tuberculosis and can result in vertebral damage, pain, and neurological symptoms [ 2 , 6 ]. Psoas abscess is an uncommon but serious complication, often arising from infection by Staphylococcus aureus or spreading from nearby sources such as spinal infections [ 5 ]. Pulmonary tuberculosis continues to pose a major global health challenge due to its high incidence and infectious potential [ 1 , 3 ].Although each of these conditions may occur separately, their simultaneous presentation is rare yet clinically important. Spinal TB can sometimes progress to form a cold abscess, which may track along fascial planes into the psoas muscle, resulting in abscess formation [ 6 , 7 ]. Approximately 50% of skeletal TB cases involve the spine, and skeletal TB represents 10%–35% of extrapulmonary TB cases [ 6 ]. Psoas abscesses are estimated to affect 0.4 per 100,000 individuals, though the actual prevalence may be underestimated due to a lack of routine testing in patients without symptoms [ 5 ].According to the WHO Global TB Report 2022, around 10.6 million new TB cases were reported worldwide in 2021, reinforcing the continued public health burden of tuberculosis [ 1 ]. The END TB strategy aims to reduce global TB deaths by 95% and incidence by 90% by 2035 [ 4 ]. Disruptions in spinal curvature, such as cervical lordosis reversal, can lead to chronic functional impairments if not addressed promptly. As per ICMR guidelines, early detection using MRI and immediate initiation of anti-tubercular therapy are essential to prevent long-term deformities and complications [ 8 ].The simultaneous presence of pulmonary TB, spinal involvement, and paraspinal abscesses remains uncommon due to the generally localized behavior of TB. However, delays in diagnosis and treatment can lead to such severe outcomes, highlighting the critical importance of early clinical recognition and integrated care. CASE REPORT A 16-year-old female patient from a lower-middle-class background was admitted to the pediatrics ward with chief complaints of inability to stand upright due to bilateral lower limb weakness for 20 days, back pain for one month, and cough for six months. She experienced severe back pain aggravated by movement, accompanied by reduced appetite and fatigue. There was no known family history of tuberculosis, though her father had chronic cough suggestive of possible exposure. Nutritional assessment indicated mild undernutrition, and vaccination history was complete per national immunization schedule.Laboratory investigation results are shown in Table 1 . Figure 1 demonstrates the lateral cervical spine X-ray demonstrated reversal of cervical lordosis, indicating spinal alignment disturbance potentially due to cervical involvement in tuberculosis. Figure 2 (A) depicts MRI of the lumbo-sacral spine revealed sacralization of L5, straightening of the lumbar spine, and significant involvement of L2 and L3 vertebrae with endplate erosion, fracture, and disc space narrowing. Figure 2 (B) illustrates Bilateral psoas abscesses and epidural collection were noted. Whole-spine screening showed cervical lordosis reversal and disc protrusions at C3–C6. HRCT chest demonstrated active pulmonary tuberculosis, and a positive Mantoux test (12 mm induration) confirmed prior TB exposure. Abdominal ultrasound revealed hepatomegaly and gall bladder sludge. The patient was diagnosed with Pott’s spine, pulmonary tuberculosis, bilateral psoas abscess, and cervical lordosis. During hospitalization, she developed severe bradycardia, with pulse rate dropping below 30 beats per minute, necessitating ICU admission.The anti-tubercular regimen is shown in Table 2 , comprising a fixed-dose combination of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol (HRZE) along with Pyridoxine to prevent drug-induced neuropathy. Other medications administered during hospitalization included Ceftriaxone, Diclofenac, Paracetamol, Ibuprofen, Prednisolone, Tolperisone, Alprazolam, Calcium, Vitamin D3, Labetalol, Nifedipine, Amlodipine, Prazosin, Potassium chloride, Zinc, Lactulose, topical emollient, Ipratropium bromide, Salbutamol, and an antitussive syrup.At discharge, the patient was prescribed Paracetamol, Pyridoxine, Pantoprazole, Linezolid, and continuation of the anti-tubercular regimen (HRZE) with Becosules. She was discharged in a stable condition with partial neurological recovery and advised for regular follow-up.At 3-month follow-up, the patient showed significant improvement in back pain and gait, with partial resolution of psoas abscesses on ultrasound. By 6 months, she regained near-normal mobility, no neurological deficits were observed, and inflammatory markers normalized. Repeat MRI demonstrated reduced vertebral inflammation and near-complete abscess resolution, confirming effective therapeutic response. Table 1 LABORATORY INVESTIGATIONS PARAMETER RESULT(BEFORE TRANSFUSION) RESULT(AFTER TRANSFUSION) REFERENCE RANGE UNIT HEMATOLOGY TESTS Hemoglobin (Hb) 6.7 9.0 12–16 g/dL Total Leukocyte Count (TLC) 21.9 14.1 4–11 *10 3 /cumm Total Red Blood Cell Count (TRBC) 3.35 3.74 3.8–5.8 million/cumm ErythrocyteSedimentation Rate (ESR) 20 16 0–10 mm/hr Segmented Neutrophils 82.8 88.8 40–75 % Lymphocytes 8.8 7.7 20–40 % PCV/HCT 43.3 27.0 38–45 % MCV 63.6 86.9 83–101 fL MCHC 21.3 31.6 30–35 g/dL Platelet Count 3.86 3.86 1.5–4.5 lakh/cumm LIVER FUNCTION TESTS Total Bilirubin 0.41 0.43 0–2 mg/dL SGOT 18 41 0–31 U/L SGPT 10 26 0–31 U/L Total Protein 7.6 7.0 6.4–8.3 g/dL RENAL FUNCTION TESTS Serum urea 34.82 28.63 10–50 mg/dL Serum Creatinine 1.41 0.60 0.6–1.1 mg/dL eGFR 78.85 107.91 90–120 mL/min ELECTROLYTE PROFILE Sodium(Na + ) 128.6 141.3 135–145 mmol/L Potassium (K + ) 3.52 3.39 3.5–5.1 mmol/L Chloride(Cl - ) 89.8 105.3 98–110 mmol/L IRON STUDIES Serum Iron 11.0 40.2 37–145 ug/dl Total Iron-Binding Capacity (TIBC) 211.21 252.1 250–450 ug/dl Table 2 ANTI-TUBERCULAR DRUG REGIMEN Sr.No. DRUG NAME DOSE DURATION DAY 1. Tablet FDC (HRZE)* Isoniazid 75 mg, Rifampicin 150 mg, Pyrazinamide 400 mg, Ethambutol 275 mg 1 tablet Before breakfast (BBF) Day4- Day29 2. Tablet Benadon (Pyridoxine-Vitamin B6) 20mg Once daily Day4-Day29 *FDC- Fixed Dose Combination DISCUSSION This report presents an uncommon and severe manifestation of spinal tuberculosis (Pott’s disease) in a 16-year-old female, complicated by coexisting pulmonary TB, bilateral psoas abscess, and reversal of cervical lordosis. The condition is particularly complex due to the simultaneous involvement of the skeletal, nervous, and respiratory systems. Pott’s disease frequently progresses with symptoms such as persistent back pain, neurologic impairment, and spinal deformities, which can lead to serious outcomes if not addressed promptly. Among its complications, psoas abscesses—though infrequent—pose added risks due to their potential to cause systemic infection or rupture, occurring in around 3%–5% of spinal TB cases [ 9 ]. In pediatric patients specifically, the incidence of psoas abscess is even rarer, documented in only approximately 4.5% of spinal tuberculosis cases [ 10 ].Multiple reports in the literature have established a connection between Pott’s disease and the development of psoas abscess. In spinal tuberculosis, necrotic destruction of vertebral tissue through caseation and liquefaction may lead to the formation of paraspinal abscesses. These infectious collections tend to spread along fascial planes, particularly via the psoas sheath, due to its anatomical continuity with the lumbar vertebrae. This pathway frequently results in the formation of psoas abscesses. Tuli et al. (2013) emphasized that the psoas muscle is commonly affected because of its anatomical proximity to infected vertebral bodies [ 11 ]. In contrast, a case described by Gupta et al. (2017) involved a 14-year-old male with less severe systemic features and no evident cervical spinal deformity, illustrating the range of disease presentations [ 12 ]. Another report by de Souza et al. (2022) discussed a 23-year-old female diagnosed with Pott’s disease complicated by psoas abscess, requiring surgical drainage and extended anti-tubercular therapy [ 13 ]. In contrast to these reports, the present case stands out for the simultaneous occurrence of cervical lordosis reversal, extensive L2–L3 vertebral destruction, and severe autonomic disturbance (bradycardia). This constellation of findings represents an exceptional presentation not widely described in pediatric populations, suggesting a more aggressive and systemic disease course.Changes in cervical lordosis are an important clinical feature in cases of spinal tuberculosis. According to Been et al. (2014), such postural alterations may develop due to persistent inflammation, structural damage from infection, or compensatory spinal mechanisms [ 14 ]. These findings align with our patient’s imaging results, which showed reversed cervical curvature along with lumbar spine involvement, indicating the extensive biomechanical disruption caused by TB.In this patient, the reversal of cervical lordosis was most likely secondary to reflex paraspinal muscle spasm induced by inflammation, rather than fixed osseous deformity. Inflammatory edema and pain can trigger protective muscle contraction, producing temporary straightening of the cervical curvature a reversible adaptive change that improves as inflammation subsides. This hypothesis aligns with findings by Kumar et al. (2020), who observed that postural correction frequently follows anti-tubercular therapy and physiotherapy initiation [ 15 ].Another striking feature was the occurrence of severe bradycardia, with the pulse rate dropping below 30 beats per minute during hospitalization.Bradycardia in spinal tuberculosis is a rare but clinically significant phenomenon. Possible mechanisms include autonomic dysfunction due to epidural extension or compression of sympathetic pathways in the spinal cord, or drug-induced suppression from agents such as Labetalol. Sharma et al. (2021) reported similar autonomic dysregulation in spinal infections, suggesting that inflammation near the thoracolumbar sympathetic outflow can transiently alter cardiac rhythm. The resolution of bradycardia following reduction of inflammation and careful medication adjustment supports this pathophysiological explanation in our patient.A key factor influencing the progression of this case was the patient’s socioeconomic status. As a member of a lower-middle-class family, she faced barriers to accessing timely and specialized healthcare.Limited access to early imaging and specialist care contributed to delayed diagnosis and the progression to complex complications, including neurological involvement. In India, tuberculosis disproportionately affects socioeconomically disadvantaged groups due to overcrowding, malnutrition, and poor health literacy. These conditions result in delayed diagnosis and incomplete treatment, as emphasized by Lönnroth et al. (2015) [ 16 ]. Nutritional deficiency in this patient may also have compromised immune response, promoting severe disease dissemination.Follow-up imaging and laboratory evaluation at three and six months post-treatment showed marked clinical improvement, normalization of inflammatory markers (ESR and CRP), and partial resolution of psoas abscesses on MRI. These findings reinforce the importance of sustained anti-tubercular therapy and close monitoring. The patient’s functional mobility also improved progressively with physiotherapy and nutritional supplementation.This case underscores the critical importance of early detection, MRI-based assessment, and coordinated management in spinal tuberculosis, particularly when complicated by abscess formation and systemic manifestations. Although psoas abscess is an acknowledged but infrequent complication, its coexistence with cervical alignment abnormalities and autonomic disturbance makes this case unique. Optimal outcomes are achievable through a multidisciplinary approach, integrating anti-tubercular therapy, corticosteroids, physiotherapy, and vigilant supportive care. Migliori et al. (2018) emphasize the importance of long-term rehabilitation to prevent permanent deformity and disability [ 17 ].From a public health standpoint, this case highlights the necessity of improving tuberculosis awareness, promoting early diagnostic access, and ensuring socioeconomic equity in healthcare. Strengthening community-based programs for TB control, combined with nutritional and rehabilitation support, is essential to reducing disease burden in pediatric populations. CONCLUSION This case highlights the importance of early diagnosis and multidisciplinary management in spinal tuberculosis with rare complications such as bilateral psoas abscess, cervical spine misalignment, and pulmonary involvement. The delayed presentation with severe anemia, electrolyte imbalance, and vertebral destruction underscores the need for prompt imaging and comprehensive evaluation to prevent neurological sequelae.Reversal of cervical lordosis in pediatric spinal TB should alert clinicians to possible multisite involvement, prompting whole-spine MRI for timely intervention. Transient bradycardia observed during hospitalization may indicate autonomic dysfunction secondary to spinal cord compression, warranting cardiac monitoring.With appropriate anti-tubercular therapy and supportive care, the patient showed gradual neurological and functional improvement over follow-up. This case reinforces that early suspicion and coordinated care are crucial to reducing morbidity and achieving recovery in complex pediatric Pott’s disease. Declarations CONFLICT OF INTEREST The authors declare that they have no conflicts of interest relevant to this manuscript. No funding was received for this study, and all authors have reviewed and approved the final version of the manuscript. Ethical approval: Ethical Approval for this study was waived by the Institutional Ethics Committee of Jaipur National University in accordance with the National Ethical Guideliens for Biomedical Research issued by ICMR. Consent to Participate: Informed consent was obtained from the patient for participation in the study. Consent for Publication: Informed consent was obtained from the patient’s guardian for publication of this case report and the images. Data Availability Statement: All data generated or analyzed during this study are included in this published article. Funding Declaration: The authors received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Conflict of interest: There are no conflict of interest Clinical Trial Number: Not applicable Clinical Trial Registration: Not applicable Author Contribution DC contributed to data collection, manuscript drafting, and literature review.HS assisted in data interpretation and manuscript preparation.JS provided clinical supervision, diagnosis details, and case verification.YG contributed to manuscript revision and technical guidance RS reviewed all the data.All authors reviewed and approved the final manuscript. References World Health Organization. Global Tuberculosis Report 2022. Geneva: WHO; 2022. Pott P. The Classic Description of Pott’s Disease. Med Hist. 1779;23(4):45–9. Centers for Disease Control and Prevention. Tuberculosis Data and Statistics. Centers for Disease Control and Prevention Tuberculosis Data and Statistics. 2022. World Health Organization. WHO END TB Strategy. Geneva: WHO; 2015. Barreto AR, Siqueira MG, Nogueira EF. Epidemiology of Psoas Abscess: Incidence and Clinical Characteristics. J Infect Public Health. 2021;14(8):1034–9. Jain AK. Tuberculosis of the Spine: A Review of Literature. Clin Orthop Relat Res. 2007;460:39–49. Leder K, Weller PF. The Impact of Global Migration on Tuberculosis Epidemiology. Clin Infect Dis. 2020;71(12):2971–8. Indian Council of Medical Research. Guidelines for the Management of Pediatric Tuberculosis. New Delhi: ICMR; 2021. Moon MS. Tuberculosis of the spine: controversies and a new challenge. Spine. 1997;22:1791–7. Dharmalingam M. Psoas abscess in spinal tuberculosis. Int J Tuberc Lung Dis. 2002;6(11):1009–12. Tuli SM. Historical aspects of Pott’s disease (spinal tuberculosis) management. Eur Spine J [Internet]. 2013;22 Suppl 4(S4):529–38. Available from: http://dx.doi.org/10.1007/s00586-012-2388-7 Gupta S, Sodhi KS, Sinha A. Pott’s spine in a 14-year-old male: case report and review of literature. J Pediatr Orthop B. 2017;26(4):356–61. De Souza JR, Rodrigues AM, Lima ME. Pott’s disease with psoas abscess: a case report and literature review. Int J Infect Dis. 2022;116:189–93. Been E, Kalichman L. Lumbar lordosis. Spine J. 2014;14(1):87–97. Kumar R, Gupta N, Jindal N. Imaging in Pott’s disease: a review. J Clin Orthop Trauma. 2020;11(4):760–7. Pai M, Kasaeva T, Swaminathan S. Covid-19’s devastating effect on tuberculosis care - a path to recovery. New England Journal of Medicine [Internet]. 2022;386(16):1490–3. Available from: http://dx.doi.org/10.1056/NEJMp2201164 Migliori GB, Centis R, Ambrosio D. Multidisciplinary and comprehensive approach in the treatment of spinal tuberculosis. Eur Respir J. 2018;51(3). Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":361120,"visible":true,"origin":"","legend":"\u003cp\u003eLateral cervical spine X-ray demonstrating reversal of cervical lordosis, indicating spinal alignment disturbance potentially due to cervical involvement in tuberculosis.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8172665/v1/8356233baf8fabd0efda67be.png"},{"id":98423722,"identity":"a00209e5-5637-435f-ac1a-9b11d994c87e","added_by":"auto","created_at":"2025-12-17 16:32:33","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1280393,"visible":true,"origin":"","legend":"\u003cp\u003e[A] Sagittal MRI of the lumbosacral spine showing sacralization of L5, straightening of the lumbar spine, endplate erosion, and disc space narrowing at L2-L3, consistent with spinal tuberculosis (Pott’s disease).\u003c/p\u003e\n\u003cp\u003e[B] Axial MRI image of the lumbar spine revealing bilateral psoas abscesses and epidural collection, indicative of advanced spondylodiscitis associated with Pott’s disease.Written informed consent for publication was obtained from the patient’s guardian.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8172665/v1/c91e015b5fffc22c69477ab6.jpeg"},{"id":102296763,"identity":"454a0fe1-0bbb-4ae9-8b8b-6a8ff4e3a2c4","added_by":"auto","created_at":"2026-02-10 10:21:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2181979,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8172665/v1/5cdc6d82-9c4c-45e0-923b-4f966d66ef95.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eUnusual Co-Presentation of Cervical Lordosis Reversal and Bilateral Psoas Abscess in a Pediatric Patient with Spinal Tuberculosis\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCervical lordosis refers to the normal inward curvature of the neck region of the spine, which is essential for maintaining head balance, posture, and overall spinal alignment. Pott\u0026rsquo;s disease, also known as spinal tuberculosis, is caused by \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e and can result in vertebral damage, pain, and neurological symptoms [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Psoas abscess is an uncommon but serious complication, often arising from infection by \u003cem\u003eStaphylococcus aureus\u003c/em\u003e or spreading from nearby sources such as spinal infections [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Pulmonary tuberculosis continues to pose a major global health challenge due to its high incidence and infectious potential [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].Although each of these conditions may occur separately, their simultaneous presentation is rare yet clinically important. Spinal TB can sometimes progress to form a cold abscess, which may track along fascial planes into the psoas muscle, resulting in abscess formation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Approximately 50% of skeletal TB cases involve the spine, and skeletal TB represents 10%\u0026ndash;35% of extrapulmonary TB cases [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Psoas abscesses are estimated to affect 0.4 per 100,000 individuals, though the actual prevalence may be underestimated due to a lack of routine testing in patients without symptoms [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].According to the WHO Global TB Report 2022, around 10.6\u0026nbsp;million new TB cases were reported worldwide in 2021, reinforcing the continued public health burden of tuberculosis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The END TB strategy aims to reduce global TB deaths by 95% and incidence by 90% by 2035 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Disruptions in spinal curvature, such as cervical lordosis reversal, can lead to chronic functional impairments if not addressed promptly. As per ICMR guidelines, early detection using MRI and immediate initiation of anti-tubercular therapy are essential to prevent long-term deformities and complications [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].The simultaneous presence of pulmonary TB, spinal involvement, and paraspinal abscesses remains uncommon due to the generally localized behavior of TB. However, delays in diagnosis and treatment can lead to such severe outcomes, highlighting the critical importance of early clinical recognition and integrated care.\u003c/p\u003e"},{"header":"CASE REPORT","content":"\u003cp\u003eA 16-year-old female patient from a lower-middle-class background was admitted to the pediatrics ward with chief complaints of inability to stand upright due to bilateral lower limb weakness for 20 days, back pain for one month, and cough for six months. She experienced severe back pain aggravated by movement, accompanied by reduced appetite and fatigue. There was no known family history of tuberculosis, though her father had chronic cough suggestive of possible exposure. Nutritional assessment indicated mild undernutrition, and vaccination history was complete per national immunization schedule.Laboratory investigation results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e demonstrates the lateral cervical spine X-ray demonstrated reversal of cervical lordosis, indicating spinal alignment disturbance potentially due to cervical involvement in tuberculosis. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003e(A)\u003c/b\u003e depicts MRI of the lumbo-sacral spine revealed sacralization of L5, straightening of the lumbar spine, and significant involvement of L2 and L3 vertebrae with endplate erosion, fracture, and disc space narrowing. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003e(B)\u003c/b\u003e illustrates Bilateral psoas abscesses and epidural collection were noted. Whole-spine screening showed cervical lordosis reversal and disc protrusions at C3\u0026ndash;C6. HRCT chest demonstrated active pulmonary tuberculosis, and a positive Mantoux test (12 mm induration) confirmed prior TB exposure. Abdominal ultrasound revealed hepatomegaly and gall bladder sludge.\u003c/p\u003e\u003cp\u003eThe patient was diagnosed with Pott\u0026rsquo;s spine, pulmonary tuberculosis, bilateral psoas abscess, and cervical lordosis. During hospitalization, she developed severe bradycardia, with pulse rate dropping below 30 beats per minute, necessitating ICU admission.The anti-tubercular regimen is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, comprising a fixed-dose combination of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol (HRZE) along with Pyridoxine to prevent drug-induced neuropathy.\u003c/p\u003e\u003cp\u003eOther medications administered during hospitalization included Ceftriaxone, Diclofenac, Paracetamol, Ibuprofen, Prednisolone, Tolperisone, Alprazolam, Calcium, Vitamin D3, Labetalol, Nifedipine, Amlodipine, Prazosin, Potassium chloride, Zinc, Lactulose, topical emollient, Ipratropium bromide, Salbutamol, and an antitussive syrup.At discharge, the patient was prescribed Paracetamol, Pyridoxine, Pantoprazole, Linezolid, and continuation of the anti-tubercular regimen (HRZE) with Becosules. She was discharged in a stable condition with partial neurological recovery and advised for regular follow-up.At 3-month follow-up, the patient showed significant improvement in back pain and gait, with partial resolution of psoas abscesses on ultrasound. By 6 months, she regained near-normal mobility, no neurological deficits were observed, and inflammatory markers normalized. Repeat MRI demonstrated reduced vertebral inflammation and near-complete abscess resolution, confirming effective therapeutic response.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLABORATORY INVESTIGATIONS\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePARAMETER\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRESULT(BEFORE TRANSFUSION)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRESULT(AFTER TRANSFUSION)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eREFERENCE RANGE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUNIT\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eHEMATOLOGY TESTS\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin (Hb)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u0026ndash;16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Leukocyte Count (TLC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u0026ndash;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e*10\u003csup\u003e3\u003c/sup\u003e/cumm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Red Blood Cell Count (TRBC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.8\u0026ndash;5.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003emillion/cumm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eErythrocyteSedimentation Rate (ESR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003emm/hr\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSegmented Neutrophils\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40\u0026ndash;75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphocytes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCV/HCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMCV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83\u0026ndash;101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003efL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMCHC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlatelet Count\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.5\u0026ndash;4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003elakh/cumm\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLIVER FUNCTION TESTS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Bilirubin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u0026ndash;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003emg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSGOT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u0026ndash;31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eU/L\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSGPT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u0026ndash;31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eU/L\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Protein\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.4\u0026ndash;8.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRENAL FUNCTION TESTS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSerum urea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003emg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSerum Creatinine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.6\u0026ndash;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003emg/dL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eeGFR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90\u0026ndash;120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003emL/min\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eELECTROLYTE PROFILE\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSodium(Na\u003csup\u003e+\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e141.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e135\u0026ndash;145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003emmol/L\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePotassium (K\u003csup\u003e+\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.5\u0026ndash;5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003emmol/L\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChloride(Cl\u003csup\u003e-\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e105.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98\u0026ndash;110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003emmol/L\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIRON STUDIES\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSerum Iron\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37\u0026ndash;145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eug/dl\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Iron-Binding Capacity (TIBC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e211.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e252.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e250\u0026ndash;450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eug/dl\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eANTI-TUBERCULAR DRUG REGIMEN\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSr.No.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDRUG NAME\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDOSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDURATION\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDAY\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTablet FDC (HRZE)*\u003c/p\u003e\u003cp\u003eIsoniazid 75 mg, Rifampicin 150 mg, Pyrazinamide 400 mg, Ethambutol 275 mg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 tablet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBefore breakfast (BBF)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDay4- Day29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTablet Benadon\u003c/p\u003e\u003cp\u003e(Pyridoxine-Vitamin B6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20mg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOnce daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDay4-Day29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*FDC- Fixed Dose Combination\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis report presents an uncommon and severe manifestation of spinal tuberculosis (Pott\u0026rsquo;s disease) in a 16-year-old female, complicated by coexisting pulmonary TB, bilateral psoas abscess, and reversal of cervical lordosis. The condition is particularly complex due to the simultaneous involvement of the skeletal, nervous, and respiratory systems. Pott\u0026rsquo;s disease frequently progresses with symptoms such as persistent back pain, neurologic impairment, and spinal deformities, which can lead to serious outcomes if not addressed promptly. Among its complications, psoas abscesses\u0026mdash;though infrequent\u0026mdash;pose added risks due to their potential to cause systemic infection or rupture, occurring in around 3%\u0026ndash;5% of spinal TB cases [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In pediatric patients specifically, the incidence of psoas abscess is even rarer, documented in only approximately 4.5% of spinal tuberculosis cases [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].Multiple reports in the literature have established a connection between Pott\u0026rsquo;s disease and the development of psoas abscess. In spinal tuberculosis, necrotic destruction of vertebral tissue through caseation and liquefaction may lead to the formation of paraspinal abscesses. These infectious collections tend to spread along fascial planes, particularly via the psoas sheath, due to its anatomical continuity with the lumbar vertebrae. This pathway frequently results in the formation of psoas abscesses. Tuli et al. (2013) emphasized that the psoas muscle is commonly affected because of its anatomical proximity to infected vertebral bodies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In contrast, a case described by Gupta et al. (2017) involved a 14-year-old male with less severe systemic features and no evident cervical spinal deformity, illustrating the range of disease presentations [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Another report by de Souza et al. (2022) discussed a 23-year-old female diagnosed with Pott\u0026rsquo;s disease complicated by psoas abscess, requiring surgical drainage and extended anti-tubercular therapy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn contrast to these reports, the present case stands out for the simultaneous occurrence of cervical lordosis reversal, extensive L2\u0026ndash;L3 vertebral destruction, and severe autonomic disturbance (bradycardia). This constellation of findings represents an exceptional presentation not widely described in pediatric populations, suggesting a more aggressive and systemic disease course.Changes in cervical lordosis are an important clinical feature in cases of spinal tuberculosis. According to Been et al. (2014), such postural alterations may develop due to persistent inflammation, structural damage from infection, or compensatory spinal mechanisms [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These findings align with our patient\u0026rsquo;s imaging results, which showed reversed cervical curvature along with lumbar spine involvement, indicating the extensive biomechanical disruption caused by TB.In this patient, the reversal of cervical lordosis was most likely secondary to reflex paraspinal muscle spasm induced by inflammation, rather than fixed osseous deformity. Inflammatory edema and pain can trigger protective muscle contraction, producing temporary straightening of the cervical curvature a reversible adaptive change that improves as inflammation subsides. This hypothesis aligns with findings by Kumar et al. (2020), who observed that postural correction frequently follows anti-tubercular therapy and physiotherapy initiation [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].Another striking feature was the occurrence of severe bradycardia, with the pulse rate dropping below 30 beats per minute during hospitalization.Bradycardia in spinal tuberculosis is a rare but clinically significant phenomenon. Possible mechanisms include autonomic dysfunction due to epidural extension or compression of sympathetic pathways in the spinal cord, or drug-induced suppression from agents such as Labetalol. Sharma et al. (2021) reported similar autonomic dysregulation in spinal infections, suggesting that inflammation near the thoracolumbar sympathetic outflow can transiently alter cardiac rhythm. The resolution of bradycardia following reduction of inflammation and careful medication adjustment supports this pathophysiological explanation in our patient.A key factor influencing the progression of this case was the patient\u0026rsquo;s socioeconomic status. As a member of a lower-middle-class family, she faced barriers to accessing timely and specialized healthcare.Limited access to early imaging and specialist care contributed to delayed diagnosis and the progression to complex complications, including neurological involvement. In India, tuberculosis disproportionately affects socioeconomically disadvantaged groups due to overcrowding, malnutrition, and poor health literacy. These conditions result in delayed diagnosis and incomplete treatment, as emphasized by L\u0026ouml;nnroth et al. (2015) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Nutritional deficiency in this patient may also have compromised immune response, promoting severe disease dissemination.Follow-up imaging and laboratory evaluation at three and six months post-treatment showed marked clinical improvement, normalization of inflammatory markers (ESR and CRP), and partial resolution of psoas abscesses on MRI. These findings reinforce the importance of sustained anti-tubercular therapy and close monitoring. The patient\u0026rsquo;s functional mobility also improved progressively with physiotherapy and nutritional supplementation.This case underscores the critical importance of early detection, MRI-based assessment, and coordinated management in spinal tuberculosis, particularly when complicated by abscess formation and systemic manifestations. Although psoas abscess is an acknowledged but infrequent complication, its coexistence with cervical alignment abnormalities and autonomic disturbance makes this case unique. Optimal outcomes are achievable through a multidisciplinary approach, integrating anti-tubercular therapy, corticosteroids, physiotherapy, and vigilant supportive care. Migliori et al. (2018) emphasize the importance of long-term rehabilitation to prevent permanent deformity and disability [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].From a public health standpoint, this case highlights the necessity of improving tuberculosis awareness, promoting early diagnostic access, and ensuring socioeconomic equity in healthcare. Strengthening community-based programs for TB control, combined with nutritional and rehabilitation support, is essential to reducing disease burden in pediatric populations.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis case highlights the importance of early diagnosis and multidisciplinary management in spinal tuberculosis with rare complications such as bilateral psoas abscess, cervical spine misalignment, and pulmonary involvement. The delayed presentation with severe anemia, electrolyte imbalance, and vertebral destruction underscores the need for prompt imaging and comprehensive evaluation to prevent neurological sequelae.Reversal of cervical lordosis in pediatric spinal TB should alert clinicians to possible multisite involvement, prompting whole-spine MRI for timely intervention. Transient bradycardia observed during hospitalization may indicate autonomic dysfunction secondary to spinal cord compression, warranting cardiac monitoring.With appropriate anti-tubercular therapy and supportive care, the patient showed gradual neurological and functional improvement over follow-up. This case reinforces that early suspicion and coordinated care are crucial to reducing morbidity and achieving recovery in complex pediatric Pott\u0026rsquo;s disease.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest relevant to this manuscript. No funding was received for this study, and all authors have reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eEthical Approval for this study was waived by the Institutional Ethics Committee of Jaipur National University in accordance with the National Ethical Guideliens for Biomedical Research issued by ICMR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from the patient for participation in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e Informed consent was obtained from the patient\u0026rsquo;s guardian for publication of this case report and the images.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u003c/strong\u003e The authors received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eThere are no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u003c/strong\u003e Not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration:\u003c/strong\u003e Not applicable\u0026nbsp;\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDC contributed to data collection, manuscript drafting, and literature review.HS assisted in data interpretation and manuscript preparation.JS provided clinical supervision, diagnosis details, and case verification.YG contributed to manuscript revision and technical guidance RS reviewed all the data.All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1007/s00586-012-2388-7\u003c/span\u003e\u003cspan address=\"10.1007/s00586-012-2388-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGupta S, Sodhi KS, Sinha A. Pott\u0026rsquo;s spine in a 14-year-old male: case report and review of literature. J Pediatr Orthop B. 2017;26(4):356\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDe Souza JR, Rodrigues AM, Lima ME. Pott\u0026rsquo;s disease with psoas abscess: a case report and literature review. Int J Infect Dis. 2022;116:189\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBeen E, Kalichman L. Lumbar lordosis. Spine J. 2014;14(1):87\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKumar R, Gupta N, Jindal N. Imaging in Pott\u0026rsquo;s disease: a review. J Clin Orthop Trauma. 2020;11(4):760\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePai M, Kasaeva T, Swaminathan S. Covid-19\u0026rsquo;s devastating effect on tuberculosis care - a path to recovery. New England Journal of Medicine [Internet]. 2022;386(16):1490\u0026ndash;3. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1056/NEJMp2201164\u003c/span\u003e\u003cspan address=\"10.1056/NEJMp2201164\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMigliori GB, Centis R, Ambrosio D. Multidisciplinary and comprehensive approach in the treatment of spinal tuberculosis. Eur Respir J. 2018;51(3).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","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, Pulmonary Tuberculosis, Psoas Abscess","lastPublishedDoi":"10.21203/rs.3.rs-8172665/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8172665/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBACKGROUND\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSpinal tuberculosis in children is uncommon and often remains undiagnosed due to vague symptoms. The coexistence of cervical lordosis reversal and bilateral psoas abscess is extremely rare and indicates advanced systemic disease. Early recognition is vital to prevent neurological impairment and spinal deformity.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCASE PRESENTATION\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA 16-year-old female presented with progressive lower limb weakness, severe back pain, and chronic cough. Imaging revealed Pott\u0026rsquo;s disease affecting L2\u0026ndash;L3 vertebrae, bilateral psoas abscesses, and reversal of cervical lordosis. She also had pulmonary tuberculosis, severe anemia, electrolyte imbalance, and developed bradycardia requiring ICU care. MRI confirmed vertebral destruction and epidural collection. Anti-tubercular therapy was initiated based on ICMR guidelines along with supportive management.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCONCLUSION\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis rare presentation highlights the importance of prompt imaging, early suspicion, and multidisciplinary management in pediatric spinal tuberculosis. Cervical lordosis reversal with psoas abscess signifies severe disease progression. Timely anti-tubercular treatment and supportive care can prevent long-term disability and improve recovery. The patient achieved near-complete recovery with anti-tubercular therapy and supportive care.\u003c/p\u003e","manuscriptTitle":"Unusual Co-Presentation of Cervical Lordosis Reversal and Bilateral Psoas Abscess in a Pediatric Patient with Spinal Tuberculosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-11 14:50:25","doi":"10.21203/rs.3.rs-8172665/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":"2c432b4d-bf43-4eeb-ac5a-84b71446216e","owner":[],"postedDate":"December 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T07:57:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-11 14:50:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8172665","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8172665","identity":"rs-8172665","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}