A Rare Case of Pott’s Spine with Bilateral Psoas Abscess and Empyema: A Manifestation of Disseminated Tuberculosis

Authors: SWAPNIL N. DESHMUKH, RONAK AGARWAL, VASU AGARWAL, MADHU SUDAN BARTHWAL

DOI: 10.18231/j.ijirm.12573.1758514119

Keywords: Multi-organ ,Anti-Tubercular Therapy , Immunocompetence,EPTB

Abstract: This case report describes a rare presentation of disseminated tuberculosis (TB) in a 45-year-old male presented with lower backache and left arm pain for 1.5 months and progressive breathlessness for one month. Imaging revealed left-sided empyema, Pott’s spine, bilateral psoas abscesses. Bilateral psoas abscess is an uncommon entity, and tuberculous etiology for such a presentation is even more rarely reported in immunocompetent individuals [1]. High Adenosine Deaminase (ADA) levels in the psoas abscess pus, along with the clinical picture and radiological findings, strongly suggested tuberculous etiology despite negative Cartridge Based Nucleic Acid Amplification Test (CBNAAT) results, for which Anti-Tubercular Therapy (ATT) was started empirically. This led to significant clinical improvement and a reduction in abscess size. This case highlights the diagnostic complexity of disseminated TB, especially in atypical presentations with multi-organ involvement, and underscores the importance of high index of suspicion and comprehensive investigations and of early empirical treatment even in the absence of microbiological confirmation and supported by subsequent clinical improvement.