Pediatric Pott´s disease, atypical manifestation

Abstract

Tuberculosis is one of the infectious diseases that still represents a global public health problem. Its most common extrapulmonary presentation is the vertebral form, targeting the pediatric population, and its symptomatology is variable and insidious, making early diagnosis a challenge. In 30% of patients, it manifests as fatigue, night sweats, myalgia, changes in weight, or appetite, with pain in the affected area described as the main symptom. This case involves a 2-year-old male patient brought to consultation multiple times for abdominal pain as the only symptom. Initially, he was treated for constipation, but as the symptoms persisted and worsened with alterations in gait and progressive neurological deficits, imaging studies were ordered. These revealed thoracic involvement of the vertebral bodies and an associated compressive epidural mass. Additionally, the biopsy showed granulation tissue and a distribution pattern compatible with mycobacteria. Based on these findings, a diagnosis of Pott’s disease was made, which was treated surgically with decompression and stabilization of the segment, and with anti-tuberculosis treatment leading to significant clinical improvement and satisfactory patient progress to date.

This case represents a completely atypical manifestation of Pott’s disease, as the initial complaint was not typical for this condition. Current literature does not provide evidence that recurrent abdominal pain is a first manifestation of the symptoms, highlighting the importance of presenting such cases to encourage active search for this pathology even in completely non-specific symptoms, such as abdominal pain in a fully immunized patient.