Silently Gradually Progressing Paraparesis Pott's Spine Lumbar Vertebra with Bilateral Psoas Abscess

Extrapulmonary tuberculosis (TB) can involve the spine, presenting as Pott's disease. Patients typically develop back pain, and complications, such as psoas abscess and paraplegia may occur if diagnosis is delayed. A high index of suspicion and gadolinium-enhanced magnetic resonance imaging (MRI) are essential for early detection. Timely treatment helps prevent neurological deficits.We report the case of a 55-year-old afebrile man with progressive lower-limb weakness, unexplained weight loss, and an atraumatic vertebral fracture. MRI revealed classic cold abscesses consistent with Pott's disease of the lumbar spine, along with bilateral psoas abscesses. The patient showed good clinical recovery with conservative management using anti-tuberculous therapy.Spinal TB is a common form of extrapulmonary TB and may present with back pain, deformity, paraparesis, or psoas abscess. MRI is the preferred imaging modality. Early identification is crucial to prevent disability. This report describes a lumbar Pott's spine with bilateral psoas abscess presenting as progressive paraparesis.

A 55-year-old male presented with a 4-month history of worsening lower-limb pain, numbness, and weakness, along with weight loss and poor appetite. He had no fever, trauma, or respiratory symptoms. Examination showed lower-limb muscle wasting with preserved distal movements. MRI revealed D12/L1 spondylodiscitis with Grade 1 vertebral collapse, peripheral epidural abscess, and bilateral psoas abscesses. Laboratory tests showed lymphocytosis and significantly elevated erythrocyte sedimentation rate. Histopathology demonstrated granulomatous inflammation with caseation, and Mycobacterium TB was confirmed on acid-fast bacillus smear and polymerase chain reaction.The patient was started on Category-2 anti-TB treatment (ATT) (H, R, Z, E with pyridoxine). Hepatotoxicity required temporary cessation of HRZ; later H and R were reintroduced, Z was discontinued, and levofloxacin was added. He was managed conservatively with a long Taylor brace and multidisciplinary care.

Progressive paraparesis with atraumatic vertebral collapse should raise suspicion for Pott's spine with possible psoas abscess. Early MRI, microbiological confirmation, and timely individualized ATT - alongside careful monitoring for drug toxicity - are vital to prevent irreversible neurological damage. Conservative management can result in substantial recovery.