Pott's disease

Twenty-three year old man was admitted for assessment of lightheadedness,

increased heart rate and recurrent back pain of four months duration

associated with progressive numbness and stiffness of both legs and feet,

causing trouble in rising and in climbing stairs.

During this period, because of loss of appetite,

he lost 20 kilograms, and 2 weeks prior to admission

he experienced difficulty in urination and

erection. Physical examination revealed kyphosis,

a "hunchback" deformity, muscle atrophy,

decreased tonicity and weakness of the lower

extremities followed by decreased vibratory and

position sense, decreased rectal tone and saddle

anesthesia. Tuberculin skin test was positive.

Normal chest radiography. The cerebrospinal

fluid showed a high protein of 1121 mg/dl. The

patient underwent immediate surgery. Histopathology

revealed areas of consolidation with

central caseating necrosis (caseating granulomas)

and Langhans giant cells. Cultures taken at the

time of surgery were positive for Mycobacterium

tuberculosis. Negative for infection with human

immunodeficiency virus. Postoperatively, the

patient regained normal neurologic function

and started prompt antituberculous therapy1.