Introduction:

Osteoarticular manifestations of tuberculosis are the third most frequent presentation of extrapulmonary tuberculosis, with the axial skeleton being the most affected site, which is called tuberculous spondylodiscitis or Pott’s disease. We present a clinical case that aims to alert to this diagnosis, uncommon in primary health care, whose nonspecific and insidious clinic can hinder and delay diagnosis and treatment.

Case description:

82-year-old Portuguese man, with a personal history of Arterial Hypertension. No other relevant personal history, namely infection by the human immunodeficiency virus (HIV) or immunosuppression. He has no story of tuberculosis or risk contacts. He goes to his Health Unit with pain in the dorsal region and in the left hemithorax with about four months of evolution, with an intensity of 6 in 10, without irradiation, with partial relief with analgesic and anti-inflammatory medication, and worsening with movements. No history of trauma. He denies respiratory, neurological, and other general constitutional symptoms. On physical exam, there were no changes to the observation of the dorsal spine, namely local inflammatory signs or visible deformation of the spine, no pain on palpation, and no changes in muscle sensitivity or strength. Dorsal spine and chest X-rays were performed, and both were considered normal. Given the temporal evolution, it was decided to perform computed tomography of the dorsal spine, which revealed changes that were strongly suggestive of a spondylodiscitis process. The patient was referred to the hospital emergency service, where he was admitted for study and orientation, having a positive bone biopsy for Koch Bacillus. The diagnosis of Pott’s disease was assumed, and the patient started treatment with tuberculostatic agents.

Comment:

The most common symptom of Pott’s disease is localized pain, with progressive evolution over weeks or months, that is, a non-specific and insidious clinic, which contributes to the delay in diagnosis. Constitutional symptoms may exist, such as weight loss or fever, although these are present in less than half of the cases. Image methods, such as computed tomogra-phy and magnetic resonance Imaging, are important for diagnosis. Spine radiography is insensitive, particularly in the initial phase. After diagnosis, the treatment should be instituted quickly to improve the prognosis. The family doctor has an important role in diagnosis and in follow-up, supporting adherence to treatment and management of disease complications.

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