Pott Disease Differential Diagnoses

  • Author: Jose A Hidalgo, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: May 23, 2012
 
 

Diagnostic Considerations

Many persons with Pott disease (62-90% of patients in reported series[6, 7] ) have no evidence of extraspinal tuberculosis; this helps to complicate the physician’s ability to make a timely diagnosis. Information from imaging studies, microbiology, and anatomic pathology should help to establish the diagnosis.

The diagnosis of tuberculous spondylitis should be investigated if strong clinical suspicion exists, even if suggestive pulmonary radiology findings are absent.

Other features suggestive of tuberculosis include the following:

  • Positive tuberculin skin test (purified protein derivative [PPD]) result
  • Chest radiograph that shows apical scarring, infiltrates, or cavitary disease
  • Presence of risk factors for tuberculosis

Spinal tuberculosis should always be suspected when radiographs demonstrate a destructive spinal process.

Conditions to consider in the differential diagnosis of Pott disease include the following:

  • Spinal tumors
  • Mycobacterium kansasii
  • Nocardiosis
  • Paracoccidioidomycosis
  • Septic arthritis
  • Spinal cord abscess
  • Tuberculosis

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Jose A Hidalgo, MD  Assistant Professor, Universidad Nacional Mayor de San Marcos; Attending Physician, Department of Internal Medicine, Division of Infectious Diseases, Guillermo Almenara Hospital, Peru

Jose A Hidalgo, MD is a member of the following medical societies: HIV Medicine Association of America and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

George Alangaden, MD  Professor, Department of Internal Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University School of Medicine

George Alangaden, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, and Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Joseph F John Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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MRI of a 31-year-old man with tuberculosis of the spine. Images show the thoracic spine before and after an infusion of intravenous gadolinium contrast. The abscess and subsequent destruction of the T11-T12 disc interspace is marked with arrowheads. Vertebral body alignment is normal. Courtesy of Mark C. Diamond, MD, and J. Antonio Bouffard, MD, Detroit, Mich.
MRI of the T11 in a 31-year-old man with tuberculosis of the spine. Extensive bone destruction consistent with tuberculous osteomyelitis is evident. The spinal cord has normal caliber and signal. No evidence of spinal cord compression or significant spinal stenosis is distinguishable. Courtesy of Mark C. Diamond, MD, and J. Antonio Bouffard, MD, Detroit, Mich.
 
 
 
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