[Persistent backache in a 62 year-old male: mechanical pain?]

Area of Science:

• Orthopedics
• Infectious Diseases
• Radiology

Background:

• A 62-year-old male with a history of pulmonary tuberculosis presented with refractory back pain.
• The pain was exacerbated by physical activity and resistant to standard analgesic and anti-inflammatory treatments.

Observation:

• Initial diagnosis suggested mechanical back pain.
• Magnetic resonance imaging (MRI) revealed bone metastases, prompting referral to Internal Medicine.
• Histopathology excluded neoplastic cells, while further imaging identified vertebral abnormalities consistent with osteomyelitis-discitis and an epidural abscess.

Findings:

• The observed radiographic abnormalities and clinical presentation were compatible with Pott's disease.
• Pott's disease, a manifestation of tuberculous arthritis, affects the intervertebral joints.

Implications:

• This case highlights the importance of considering tuberculosis as a differential diagnosis for persistent back pain, even in the absence of active pulmonary disease.
• Accurate diagnosis through a combination of imaging and histopathology is crucial for effective management of Pott's disease.
• Early recognition and treatment can prevent severe complications associated with spinal tuberculosis.