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General Rehabilitation

(Kiosk 1) Complex Medical Rehabilitation of Pott’s Disease Associated Paraplegia: A Case Report

Saturday, November 18, 2023
8:00 AM – 9:15 AM CT

    Primary Author(s)

  • Jason Do, DO

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    333 Schermerhorn st, Apt 10P, New York

    • Co-Author(s)

  • Miriam Bekhit, MD, Other

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

  • Anam Purewal, MD (she/her/hers)

    Resident
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

  • Simron Gill, MD (he/him/his)

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    New york, New York

  • Lyla Khan, MD

    NRMP Candidate
    St. George's University School of Medicine
    Old Westbury, New York

  • GK

    Getahun Kifle, MD

    Attending Physician
    n/a
    Brooklyn, New York

  • SA

    Sanjeev Agarwal, MD

    Program Director
    SUNY Downstate Medical Center
    Brooklyn, New York

Case Diagnosis: A 45 year old male with paraplegia secondary to infectious complications of Pott’s disease.

Case Description or Program Description: A patient from Senegal initially presented with severe back pain of a two month duration with CT/MRI imaging revealing sacroiliac osteomyelitis, T9-10 Discitis/osteomyelitis and gluteal abscesses. Patient found to be Quantiferon gold positive for tuberculosis and underwent biopsy and drainage of his gluteal abscesses. One month later, the patient developed profound lower extremity weakness (2/5 bilateral lower extremities) and the inability to walk consequently leading to a laminectomy of T9-10 for cord decompression and drainage of spinal abscess. Patient then discharged home to follow-up with Infectious Disease service.
The patient was lost to follow-up and his medical course was complicated with wound dehiscence of the laminectomy site. Patient was readmitted for management of his post-surgical complications and treatment of his tuberculosis and osteomyelitic abscesses before being admitted to an acute rehabilitation unit.

Setting: Inpatient Rehabilitation Facility

Assessment/Results: Patient revealed improvement after a 49 day rehabilitation course complicated by additional wound dehiscence, adverse effects of antibiotics, and depression. By discharge, the patient demonstrated improvement in his functional status: regaining the ability to ambulate 35 feet with an assistive device.

Discussion (relevance): Misdiagnosis of insidious back pain is fairly common. It is paramount to maintain a broad differential diagnosis as clinicians and especially important in rare cases such as Pott’s disease with complications such as deformity, abscess, and paraplegia. Respective rehabilitation can be impacted by different aspects of the treatment course, and may require the expertise of multiple specialties for optimal management.

Conclusions: Acute rehabilitation of paraplegia secondary to Pott’s disease requires the optimization of a multi-disciplinary approach of Physiatry, Neurosurgery/Orthopedics, Infectious disease, Psychiatry, PT/OT, etc. to facilitate an optimal patients' recovery course.