Do Not Forget Tuberculosis: A Case with Potentially Devastating Consequences
Juan Pablo Espinosa1, Camelia Valhuerdi Porto2, Efe Fakir1, Julie Leegwater-Kim3
1Neurology, Tufts Medical Center, 2Neurology/Neurocritical care, Johns Hopkins Hospital, 3Neurology, Lahey Hospital Medical Center
Objective:
To highlight a case of cervical cord compression secondary to spinal tuberculosis (Pott’s disease) presenting without pulmonary symptoms, leading to diagnostic delay.
Background:
Spinal tuberculosis is the most common form of extrapulmonary TB but is rare in non-endemic countries such as the United States. Delayed recognition can result in irreversible neurological disability. Early diagnosis and treatment are critical to prevent poor outcomes.
Design/Methods:
Case report and literature review.
Results:
A 33-year-old woman from the Philippines presented with two months of progressive right upper-extremity pain and weakness, later developing left hand numbness and mild leg weakness. Initially managed by orthopedics and primary care for presumed bursitis, her diagnosis was delayed nearly three months despite progressive neurological symptoms. Neurology evaluation revealed right arm orbiting, mild left hip flexor weakness, diffuse hyperreflexia, and a left Babinski sign.
MRI demonstrated a C5–C6 paraspinal extramedullary mass with cord edema and vertebral lytic lesions. Despite findings consistent with spinal infection, surgical planning initially focused on metastatic disease—an unlikely etiology in a young, otherwise healthy patient—further delaying appropriate therapy. CT chest/abdomen/pelvis showed para-aortic lymphadenopathy, hepatic hypodensities, and small pulmonary nodules. Dexamethasone improved symptoms, and posterior cervical laminectomy and biopsy revealed necrotizing granulomas.
Cultures initially grew Cutibacterium modestum; empiric ceftriaxone was continued. Few weeks later a positive QuantiFERON-TB Gold prompted re-evaluation, and delayed tissue culture confirmed Mycobacterium tuberculosis complex. RIPE therapy was initiated and patient had significant neurological improvement.
Conclusions:
Spinal tuberculosis should remain a differential consideration for cord compression, particularly in patients from endemic regions, even in the absence of pulmonary findings. Anchoring bias toward more common or malignant etiologies can delay diagnosis and worsen outcomes. Early recognition and initiation of anti-tuberculous therapy are vital to prevent irreversible deficits. This case underscores the need for global awareness and critical diagnostic reasoning in neurological practice.
Keywords: spinal tuberculosis, Pott’s disease, cord compression
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