Is It Back Pain or Pott's Disease?

Tuberculosis is a public health problem in Portugal. It can have extrapulmonary manifestations, with the spine being the most frequent and significant location affected within the bone area. We present the case of a 65-year-old man with left lumbar sciatic pain, 11% body weight loss, and anorexia. Later, he developed left crural hemiparesis and hypoesthesia, failing to respond to analgesia. A computerized tomography scan of the lumbar spine showed L5-S1 spondylodiscitis. The patient was admitted for study and started empirical antibiotic therapy. Due to lack of clinical and analytical response and inconclusive bone biopsy, surgical decompression of the lumbar abscess was performed, with isolation of multi-sensitive Mycobacterium tuberculosis. He took anti-tuberculostatic drugs for a year and did physiotherapy, fully recovering from neurological deficits due to his illness. On account of tuberculosis's prolonged and non-specific clinical presentation, a high index of clinical suspicion is needed for a well-timed diagnosis and treatment to prevent serious complications.