A70-25 The Hidden Burden of Tuberculosis: Pulmonary and Spinal Involvement With Psoas Abscess Formation

Abstract Introduction Spinal Tuberculosis (TB) is a form of extrapulmonary TB. Delayed diagnosis can lead to abscess formation, spinal destruction and neurologic impairment. Case Presentation A 36-year-old male with no known chronic illness presented with a one-year history of productive cough with yellow-green sputum, intermittent fever, weight loss, loss of appetite, and night sweats. He also reported chest pain associated with coughing and post-tussive vomiting. Two months prior to presentation, he developed a painful swelling over the lower back with bilateral hip pain.Computed Tomography (CT) Chest, Abdomen and Pelvis revealed thick walled, air filled cavitations in the right upper lobe 7.0 x 6.3 x 6.0 cm and demonstrates tuberculous spondylodiscitis at T11/ T12 and L4/ L5 with extensive right iliopsoas and paravertebral abscesses approximately 498 mls and a smaller left-sided collection 23 mls. The patient’s sputum PCR was positive for Mycobacterium Tuberculosis and Acid Fast Bacilli smear was positive. The mantoux test was positive at 12 mm. C13 was negative. The patient had a left flank abscess, that was post incision and drainage before coming to our institution.The wound now measures 4 × 3 cm with healthy granulation tissue and minimal purulent discharge; wound swab showed no growth.The patient was admitted and commenced on standard R.I.P.E therapy Rifampicin, Isoniazide, Pyrizinamide and Ethambutol. Subsequent sputum culture grew Klebsiella Pneumoniae, for which he completed a 10-day course of intravenous ceftriaxone. Follow-up imaging confirmed persistent but improving pulmonary and spinal TB features. Discussion Mycobacterium tuberculosis (TB) is transmitted via aerosolized droplets, leading to primary pulmonary infection that may progress to latent or extrapulmonary disease. Spinal tuberculosis (Pott’s disease) arises primarily through hematogenous dissemination via the Batson venous plexus and most commonly affects the thoracolumbar region. Spinal TB leads to destruction of vertebral body and intervertebral discs, resulting in vertebral collapse, gibbus deformity, and potential neurological deficits due to spinal cord compression. Advanced cases may form cold abscesses. MRI is the most sensitive modality and microbiological confirmation through biopsy and molecular assay are essential for diagnosis, but can often be delayed due to non-specific symptoms. The standard treatment remains the R.I.P.E regimen administered for six to twelve months. Conclusion This case highlights that in resource-limited settings, recognition and initiation of anti-TB therapy based on clinical, microbiological, and CT findings are crucial to managing pulmonary and spinal tuberculosis. This abstract is funded by: None