Atypical Presentation of Pediatric Spinal Tuberculosis as Chronic Abdominal Pain: A Case Report

Spinal tuberculosis, also known as Pott's disease, in children is a rare manifestation of extrapulmonary tuberculosis. The nonspecific clinical features, such as chronic abdominal pain, of extrapulmonary TB or spinal TB in children tend to delay diagnosis. We present the case of a 14-year-old girl who has been suffering from abdominal and backpain associated with spinal tuberculosis. This is a case study reporting on the treatment and outcome of a 14-year-old girl who presented with progressive lower abdominal and back pains for 6 months, accompanied by slight kyphotic deformity. The involvement in this case was multilevel dorsal vertebral destruction from D5 to D12, and both paravertebral and right psoas abscesses on the magnetic resonance imaging and thin-section computed tomography scans were very suggestive of spinal tuberculosis. A biopsy during the operations was not done; the treatment strategy and the plan were based on the diagnosis made from the clinical presentation and imaging studies. The justification for not doing the biopsy when the clinical features and imaging became concordant with the diagnosis of spinal tuberculosis would mean giving less importance to the biopsy result. Clinical and radiological improvement was good, with some improvement in the angle from 38° to 22° and VAS score for pain from 8/10 to 2/10 after 6 months. The treatment plan consisted of posterior surgical decompression and stabilization with anti-tubercular therapy for 12 months. This particular case underscores the fact that tuberculosis of the spine can have a presenting symptom of chronic abdominal pain in children. Radiographic assessment plays a pivotal role when histologic confirmation is impossible initially, and prompt multidisciplinary care, including radiology and anti-tuberculosis treatment, prevents catastrophic consequences.