Spinal Tuberculosis (Pott's disease) Mimicking Paravertebral Malignant Tumor in a Child Presenting with Spinal Cord Compression
A 3-year-old boy was admitted to our hospital with a 6-month history of gait disturbance and back pain. After spinal magnetic resonance imaging (MRI) revealed a tumoral mass at L1 with cord compression, malignancy was suspected, and our oncology department was consulted. His past history was uneventful. There was no known family history of any disease, including exposure to tuberculosis. He had no history of fever, significant weight loss, or night sweats. On physical examination he had back pain and tenderness of the paravertebral region from L1 to L3. Neurological examination showed grade 3/5 motor weakness in the lower extremities, hyperalgesia below the level of L1 vertebra, hyporeflexia of deep tendon reflexes on the lower extremities. Laboratory examination revealed mild anemia and a slightly elevated erythrocyte sedimentation rate (36 mm/h). Chest X-ray was unremarkable. X-ray of the spine showed destruction of the L1 vertebral body and angulation of the lumbar region []. Spinal MRI revealed a destructive mass at the level of the L1 vertebra with soft tissue infiltration and compression of the spinal cord [Figures and ]. On suspicion of malignancy, the patient underwent an open surgical biopsy. During surgery, a seropurulent fluid was discharged and sent for microbiological examination. Microscopic examination for acid-fast bacilli, via staining, and culture for tuberculosis were negative. For culture incubation Löwenstein Jensen medium was used for 21 days. Pathologic examination revealed necrotizing granulomatous inflammation composed of epithelioid cells, lymphocytes, and Langhan's giant cells; consistent with tuberculosis [].\nThe purified protein derivative (PPD) test was 14 -15 mm. positive. The patient was administered four-drug chemotherapy (isoniazid 15 mg/kg; rifampicin 10 mg/kg; pirazinamide 30 mg/kg and streptomycin 20 mg/kg) for 2 months. After 4 weeks of four-drug antituberculosis therapy, the symptoms improved, and he gained weight. When a detailed family history was taken again, we realized that his grandfather had been diagnosed with tuberculosis. We referred him to the neurosurgery clinic for spinal surgical treatment. We administered four-drug treatment for 2 months and planned to continue antituberculosis treatment with two drugs for 1 year.