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• W2980973170 abstract "SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Tuberculosis (TB) is caused by Mycobacterium tuberculosis (MTB), an acid-fast bacteria (AFB) that is typically transmitted via inhalation of infectious aerosol particles. MTB typically causes pulmonary disease with cavitary lesions, but can also affect extrapulmonary organs. Here we present a rare case of noncontiguous spinal TB (Pott’s disease). CASE PRESENTATION: A 22-year old man, who immigrated from Myanmar in January 2017 with no past medical history, presented to the emergency room with complaints of sharp low back pain for 2 weeks. The pain worsened with activity, and was associated with 20-pound weight loss over one month and drenching night sweats. Computed tomography (CT) scan of lumbar spine revealed lytic lesions in L2 vertebra and left iliac bone. Subsequent CT scan of chest, abdomen, and pelvis revealed additional lytic lesions in 7th rib, T1 and T4 vertebrae, as well as tree-in-bud infiltrates in the right lower lobe of the lung with multiple enlarged mediastinal and supraclavicular lymph nodes. Positron emission tomography scan showed hypermetabolic uptake in the described bony lesions, raising concern for metastatic malignancy versus TB. Two sputum AFB cultures were negative, still leaving the diagnosis unclear. Patient subsequently underwent bone biopsy, as well as endobronchial ultrasound (EBUS)-guided biopsy of mediastinal lymph nodes. Pathology was negative for malignancy, but the AFB cultures from both bone and lymph node specimens grew MTB, confirming the diagnosis of concomitant pulmonary TB with noncontiguous Pott’s disease. DISCUSSION: Multi-level noncontiguous spinal TB is an atypical form of skeletal TB that affects two noncontiguous vertebrae without destruction of the adjacent vertebral bodies and intervertebral disks. Skeletal TB accounts for up to 35 percent of extrapulmonary TB cases, and commonly involves the spine (Pott’s disease), most frequently the thoracic spine. The most likely etiology is retrograde spread via the valveless vertebral venous system and less likely by arterial seeding. Concomitant pulmonary TB may not be present, frequently leading to misdiagnosis of spinal lesions as metastatic malignancy. Due to its indolent course and atypical presentation, the diagnosis is frequently delayed and can present with severe manifestations including spinal cord compression. Culture from bone biopsy is necessary for definitive diagnosis of skeletal TB. CONCLUSIONS: Noncontiguous Pott’s disease is a rare manifestation of extrapulmonary TB, and is often mistaken for other systemic disorders such as pyogenic osteomyelitis or metastatic malignancy. Due to its indolent course and atypical presentation, the diagnosis requires a high index of suspicion in patients with risk factors for TB, symptoms, and concerning findings on imaging. Reference #1: Golden MP, Vikram HR. Extrapulmonary tuberculosis: an overview. Am Fam Physician. 2005;72(9):1761-8. Reference #2: Polley P, Dunn R. Noncontiguous spinal tuberculosis: incidence and management. Eur Spine J. 2009;18(8):1096-101. DISCLOSURES: No relevant relationships by Dhruv Amratia, source=Web Response No relevant relationships by David Landzberg, source=Web Response No relevant relationships by Munish Luthra, source=Web Response No relevant relationships by Philip Yang, source=Web Response" @default.
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• W2980973170 date "2019-10-01" @default.
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• W2980973170 title "TB PRESENTING WITH BACK PAIN: A CASE OF NONCONTIGUOUS POTT'S DISEASE" @default.
• W2980973170 doi "https://doi.org/10.1016/j.chest.2019.08.577" @default.
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