Astuti Setyawati1, Yusup Subagio Sutanto1, Harsini1, Ratih Kusumadewi2, Rieva Ermawan3
1Departemen Pulmonologi dan Kedokteran Respirasi Fakultas Kedokteran Universitas Negeri Sebelas Maret, RSUD Dr. Moewardi, Surakarta
2Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Negeri Sebelas Maret, RSUD Dr. Moewardi, Surakarta
3Divisi Bedah Orthopedi Fakultas Kedokteran Universitas Negeri Sebelas Maret, RSUD Dr. Moewardi, Surakarta
Pott’s disease is a vertebral bone infection due to Mycobacterium tuberculosis. Pott’s disease can occur in 33-50% of pulmonary tuberculosis (TB) or previous history of TB infection. Pott’s disease has no typical symptoms therefore delay in diagnosis and management may cause the incidence of kyphosis and paraplegia. The early surgical decompression of Pott’s disease shows better neurological and psychological improvement. This is a case report of a 27-years-old woman with pain and a lump on her back accompanied by weakness on both legs, wet cough with phlegm, history of blood streak, low grade fever, loss of appetite and significant weight loss. There was a history of closed contact to active TB patient. The acid fast bacilli (AFB) sputum smear result was +1. Chest X-ray demonstrated active pulmonary TB lesions. The contrasted thoracic vertebra magnetic resonance imaging showed destruction of thoracic vertebra (Vth) 7th-8th with kyphosis and cold abscess which compressed the spinal canal and caused subtotal stenosis. The pathological anatomy result of the cold abscess revealed caseous necrosis, fibrosis, epitheloid cells and Langhans giant cells. The patient underwent early surgical decompression and stabilization of the Vth 5th-6th and 9th-10th followed by fisrt category anti-tuberculosis treatment (ATT). The evaluation at the end of the second month of ATT showed clinical improvement. The management of pulmonary tuberculosis with Pott’s disease and paraplegia grade III include bed rest, ATT, early surgical decompression and stabilization. The early and precise management is essential for the clinical and psychosocial improvement. (J Respir Indo. 2017; 37: 257-64)
Keywords: Pulmonary tuberculosis, pott’s disease, paraplegia, early surgical decompression