Pott's disease differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D.; Aravind Kuchkuntla, M.B.B.S[2]

Overview

Pott's disease resembles spinal tumors, spinal cord abscess, septic arthritis, metastatic cancer, multiple myeloma, miliary tuberculosis. Therefore it must be differentiated from them.

Differentiating Pott's Disease from other Diseases

Pott's disease presents with features of back pain and myelopathy and must be differentiated from the following:

Disease	Age of Presentation	Common site involved	Risk Factors	Clinical Features	Laboratory Findings	Imaging Findings
Pyogenic abscess of the spine	Any age	Lumbar spine	Diabetes mellitus	Fever Back pain Myelopathy	Elevated ESR Elevated WBC's Elevated CRP	Destruction of vertebral bodies and disc spaces Enhancement of the lesion Epidural abscess
Pott's Disease	Children and adults	Upper Lumbar spine Lower Thoracic spine	Exposure to tuberculous infection	Fever Malaise Weight loss Backache Myelopathy	Elevated ESR Normal WBC	Destruction of vertebral bodies and disc spaces Rim enhancement of the soft-tissue masses
Brucella abscess of the spine	Adults	Lumbar spine	Ingestion of unpasteurized milk	Fever Malaise Weight loss Backache	Elevated ESR Elevated WBC Elevated CRP	Intact vertebral architecture even in the presence of diffuse vertebral osteomyelitis
Vertebral Metastasis	Elderly	Thoracic spine	Presence of systemic malignancy	Bone pain at night Backache Radicular pain Myelopathy	Normal WBC Normal ESR Normal CRP	Low signal intensity on T1-weighted images Hypersignal on T2-weighted Heterogeneous enhancement

Table adopted from Spinal Tuberculosis: A Review

Additional differential diagnosis to be considered include:

• Spinal tumors
• Spinal cord abscess
• Septic arthritis
• Metastatic cancer
• Multiple myeloma
• Miliary tuberculosis