Pott's Disease

swelling lower back

Yesterday I had a very interesting young man present to the Out Patient Department.   He had fallen off a motorcycle with no injury to his back.  Histories frequently don't make sense here so you try to piece things together as best as possible.  At some point he got a penicillin shot in his derriere and shortly thereafter developed pain and swelling in his lower back with weakness in his legs.  He was seen several places and was told the problem was from an incorrectly given penicillin shot.  

note difference below 3rd  square  bone just above flash

note difference below 3rd 

square  bone just above flash

He had with him a great digital x-ray showing major destruction of L3-L4-L5 vertebral bodies (sorry my flash messed up the picture).  Exam showed an impressive midline swelling in his lower back.  

Diagnosis:  Pott's Disease,  Tuberculosis of the spine (I have not seen this since our trip to Zimbabwe)

He is fortunate it is as low in the spine as it is or he would likely have complete paralysis of his legs.  Hopefully TB meds will prevent further loss of strength in his legs.