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Pott's Disease in a Patient with Subtle Red Flags
Lauren M Cantwell1, John C Perkins2, David C V Keyes3
1Virginia Tech Carilion Emergency Medicine Residency, Roanoke, Virginia.
The Journal of Emergency Medicine
|February 4, 2018
Summary
Tuberculosis (TB) can present atypically, even without classic risk factors. Emergency physicians should consider TB in patients with concurrent vertebral osteomyelitis and psoas abscess.
Area of Science:
- Emergency Medicine
- Infectious Diseases
- Radiology
Background:
- Tuberculosis (TB) is uncommon in developed nations but remains a critical diagnosis for emergency physicians.
- TB can manifest with non-respiratory symptoms, complicating recognition.
- Prompt diagnosis is vital, especially in emergency settings.
Observation:
- A 41-year-old woman presented with back pain, later diagnosed with T12 osteomyelitis and a psoas muscle abscess via MRI.
- The patient lacked typical TB risk factors such as immunosuppression or recent travel.
- A family member's recent TB treatment history was uncovered upon further investigation.
Findings:
- Computed tomography-guided fine-needle aspiration confirmed tuberculosis as the cause of osteomyelitis and abscess.
- The case highlights TB as a potential cause of concurrent vertebral osteomyelitis and psoas abscess.
- Atypical presentations of TB require thorough patient history and diagnostic workup.
Implications:
- Emergency physicians must maintain a high index of suspicion for TB, even in patients without traditional risk factors.
- Concurrent vertebral osteomyelitis and psoas abscess should prompt consideration of tuberculosis.
- Awareness of TB's varied presentations is crucial for timely and accurate emergency department diagnoses.