Rapid Progression of Pott’s Disease after Short Term Anti-Tuberculosis Drug Discontinuation for Regimen Adjustment: Case Report

Abstract

We present a case of spinal tuberculosis (TB) whom showed significant progression of imaging findings as well as neurologic deterioration after short term discontinuation of anti-tuberculosis medication. A 26-year-old man without any clinical past history of tuberculosis complained only back pain and subtle numbness at his leg. After proper diagnosis was made based on laboratory findings by biopsy, anti TB medication was started following the recommended guidelines. However, due to drug rash at the day of medication initiation, anti TB regimen were hold for a brief duration which was less than 3 days. After that, although we were adding on TB medications step by step the patient revisited our emergency room with sudden onset of incomplete paraplegia due to prominent progression of epidural abscess and cord compression. While the progression of spinal TB is known to be insidious and gradual in most cases, this patient presented both clinical and radiographic significant progression within 2 weeks. Anti-tuberculosis medication has key role in treatment of spinal tuberculosis just like any other tuberculosis. We suggest that when discontinuing anti TB medication in the active phase of disease, extra caution must be given.