This is an indigenous man of 51 years of age belonging to the nasa ethnic group of the Goal, who had no known history of any disease, and had worked as a farmer and as a construction site operator.
The patient consulted for a clinical picture of approximately two years of evolution, which began with localized pain between the lumbar vertebrae 1 to 3, non-irradiated or migratory episodes, predominantly evening fever and night chills.
Five months after the onset of symptoms, a nodular and soft lesion of 5 cm per 5 cm appeared in the area affected by pain. Approximately one patient did not undergo skin changes or satellite lesions, whose size increased progressively to reach 8 cm.
The patient received antibiotic treatment with vancomycin for eight days, followed by 20 days with dicloxacillin and gentamicin, a period in which he continued his daily work.
In the following four months, the patient developed paresis of the left lower limb and the lumbar lesion recurred until draining a material similar to that already described. For this reason, the patient went to the operating room again with saline solution.
The patient returned to receive the antibiotic treatment described above, with which he presented partial improvement of pain; however, the other symptoms continued and the weight loss became evident (10 kg). He was able to continue the treatment with antibiotics.
This time, the lesion reappeared associated with lumbar kyphosis and right lordosis with vertex between lumbar vertebrae 1 and 2, as well as worsening of the neurological deficit in the left lower limb.
Upon admission to this center, the patient was in regular general condition and was hospitalized; treatment with oxacillin and vancomycin was started, and spinal radiographs were taken in which the lumbar CT showed the destruction of the lesions.
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Given its condition, it was a complex institution in Bogota, where its clinical history, previous management and diagnostic images were evaluated.
Since his admission Pott's disease was considered as a possible diagnosis, so we consulted with the neurocipherians.
They evaluated the case and surgically intervened the patient in order to stabilize the spine and take samples to confirm the etiology.
An intervention was performed by anterior approach to achieve spinal cord compression (TB and Genotype Instrumental stabilization). Samples were taken and sent to the Laboratory of Mycobacteria, Colombia University, where rifampicin was added, and the sensitivity was confirmed.
The polymerase chain reaction test PCR IS6110 (insertion sequence present in the M. tuberculosis complex) was also positive, while the culture was negative at 16 weeks of treatment.
The Directly Observed Treatment Short Course (DOTS) strategy without corticosteroids was used, with which the patient was satisfactorily satisfied without any neurological deficit.
