A Rare Case of Multilevel Pott's Disease With Coexistent Pulmonary Cavitary Tuberculosis and Neurogenic Bladder

Tuberculosis (TB), caused by Mycobacterium tuberculosis, is an infection that typically affects the lungs and is a common cause of morbidity and mortality around the world. Primary TB infection, or latent TB, is often asymptomatic; immunocompromised patients are more at risk of TB disease, which manifests with fever, fatigue, unexplained weight loss, night sweats, and productive cough. Although not common, infection can spread hematogenously to other parts of the body (e.g., kidneys and spine) and lead to extrapulmonary TB. Diagnosis made through microscopic examination for acid-fast bacilli (AFB), nucleic acid amplification test (NAAT), and mycobacterial culture is the gold standard. For extrapulmonary TB, additional invasive procedures, e.g., biopsy, are required for bacteriological confirmation. We report a case of suspected Pott's disease (spine TB) in a 21-year-old patient, who presented with back pain and lower-extremity weakness, and was found to have a spinal mass; biopsy revealed caseating granulomas. Multiple diagnostic studies failed to identify mycobacteria. Although no active TB history was reported, computed tomography (CT) of the lungs showed a cavitary lesion in the left upper lobe. The patient's condition improved after undergoing neurosurgical intervention and initiating rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) therapy.