Pott’s disease and scrofuloderma as presentation of clinically extrapulmonary tuberculosis in 15 years old girl: a case report

Backgrounds: Extrapulmonary tuberculosis (TB) accounts for 15–20% of all tuberculosis cases, with the lymph node being the most commonly affected organ. Spinal tuberculosis and scrofuloderma are rare manifestations of extrapulmonary TB and constitute less than 5% of the cases. Establishing the diagnosis is a challenge. Eradication and prevention of sequelae complicate further management of the disease. This study aims to describe the clinical manifestation and the management of spondylitis tuberculosis and scrofuloderma in a child. Case presentation: A 15-year-old girl came with a chief complaint of lower extremities weakness for a week following monthly chronic low back pain. She also reported a painless lesion on her back with no sign of acute inflammation. She also complained of intermittent fever with night sweats and lost 3 kilos of body weight in the last two months. From physical examination, we found a kyphotic posture and severe malnutrition. Skin examination revealed an open wound on her right lower back, size 4x3 cm, with no sign of inflammation. The tuberculin skin test was positive with 15 mm induration. The spinal magnetic resonance imaging revealed destruction of the vertebral corpus thoracal segment, hyperintense sacrum, and right ileum bone with a cold abscess, suggesting spondylitis TB. A wound biopsy with hematoxylin-eosin stain concluded chronic granulomatous inflammation and showed multinucleated giant cell Langhans-type, suggestive of cutaneous tuberculosis. Microbiology examination (PCR GeneXpert) from wound biopsy and ziehl neelsen stain failed to detect Mycobacterium tuberculosis. The patient was diagnosed with Pott’s disease and scrofuloderma. Anti-tuberculous therapy commenced, and the patient responded well after several months of treatment. Conclusions: The diagnosis of extrapulmonary TB manifests as spinal tuberculosis, and scrofuloderma could be made from clinical manifestation and imaging.