A 7-year-old male, previously healthy, from Alto Hospicio (Region of Tarapacá) with a history of a bosian mother who had been diagnosed in Chile for more than 10 years.
Normal perinatal period and national immunization schedule per day.
No history of travel abroad or contact with known tuberculosis patients, chronic coughers, or cats.
His condition lasted for a year, suffering from low back pain, right hip pain and gait claudication.
During this period, a spinal radiograph showed a dorsolumbar xiphoscoliosis associated with an expansive lesion of the right ischio-pubic branch.
The study was complemented with a pelvic MRI that showed an osteolytic lesion of the right sciatic branch, 5.6 cm in diameter, with involvement of adjacent soft tissues.
With the hypothesis of a tumor, a biopsy was performed whose histology was compatible with chronic granulomatous osteomyelitis.
The patient was treated with flucloxacillin for six weeks; however, the symptoms persisted.
Three months later, a new X-ray showed a nonspecific lytic image in L2-L3.
Upon repeat MRI, spondylodiscitis in L2-L3 was observed, associated with a large abscess in the right psoas-iliac muscle, so it was decided to admit the patient.
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On physical examination she was in good general condition palpable, pale skin, without lesions, absence of BCG scar and without lymphadenopathy.
The patient had mild scoliosis, back pain to palpation of the lumbar spine and slight claudication to the contracture.
A L2-L3 spondylodiscitis was diagnosed, with suspicion of Pott's disease associated with an abscess of the right iliac psoas.
Laboratory tests included: WBC count of 9,500 cells/mm3 (65% segmented and 20% lymphocytes), hematocrit 31%, hemoglobin 10 g/dL, platelet count of 353,000/mm3, CRP
A normal chest X-ray and a chest CT scan with bilateral and infracarinal calcified perihilar adenopathies suggestive of an old TBC.
Ig G serology for Bartonella henselae and HIV ELISA were negative.
We proceeded to puncture the psoas abscess guided by an ultrasound, draining 80 ml of purulent secretion.
Direct Gram stain, current culture, calcofluor staining, smear microscopy culture and PCR for M. tuberculosis complex were performed on this sample, all with negative results.
Sputum smears of gastric aspirate were negative.
Both the PPD of 2 UT- (20 mm) and the determination of T-SPOT®.TB were positive.
Pott's disease was diagnosed and treatment was initiated with isoniazid, rifampicin, pyrazinamide, and etambu.
In addition, the spinal cord was fixed with corset.
After 30 days, at the National Thoracic Institute, M. tuberculosis was isolated from psoas abscess, which was later confirmed at the Public Health Institute, without performing susceptibility tests.
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The patient completed her anti-tuberculosis treatment, and she remained asymptomatic.
