Spinal tuberculosis (Pott’s disease) – a rare form of tuberculosis in children

Introduction: Spinal tuberculosis (Pott’s Disease) is a secondary form of tuberculosis, which occurs in less than 1% of all infected patients with Mycobacterium tuberculosis. The clinical presentation con­sist of osteomyelitis and arthritis, resulting in local destruction of the vertebral bodies, mainly in the thoracic region of the spine. Common complications are related to neurological impairment, kypho­sis and gibbus formation. Methods and materials: We present a 4-year-old boy with normal physical and neurological develop­ment and no history of frequent infections. The child received Bacillus Calmette – Guerin (BCG) vac­cine in the neonatal period but the local reaction and the induced immunity were not evaluated sub­sequently. In October 2017 the patient was admitted to St. Marina University Hospital with clinical evidence of persistent pneumonia and lower extremity paraparesis with muscular hypertonus, as well as hyperreflexia with expanded reflex receptive fields, clonus of the lower limbs and bilaterally posi­tive Babinski sign. At the same time a tender, painful deformity in the interscapular region was pres­ent at hospitalization. Results: Diagnostic images revealed the presence of mediastinal and supraclavicular lymphadenopa­thy, significant paravertebral liquefaction in the thoracic region, destruction of vertebral bodies with spinal cord compression and formation of a gibbus. The Mantoux test was positive, the T-SPOT.TB test – negative, because of suppression of functional T-lymphocytes activity. Conclusion: Pott’s disease is a rare condition, but remains one of the most dangerous forms of second­ary tuberculosis, due to the neurological complications. Regular vaccination and strict evaluation of the induced immunity are the most important part of the preventive strategy.