Disseminated MDR tuberculosis manifesting as Pott's disease with tuberculous septic ankle arthritis: an uncommon sequential dual-site involvement.

Abstract

Disseminated osteoarticular TB is uncommon, and the occurrence of multidrug-resistant (MDR) strains impacting many skeletal locations in an immuno-competent individual is very rare. A 25-year-old male from a TB-endemic rural region is presented, having a three-month progression of worsening low back pain, subsequently accompanied by lower limb weakness. GeneXpert from both sites detected Mycobacterium tuberculosis that was resistant to rifampicin. The line probe assay detected resistance to rifampicin, high-level resistance to isoniazid, and resistance to ethambutol. After surgical procedures in the form of spinal decompression and arthrotomy, the patient had a 24-month all-oral bedaquiline-based treatment. Neurological recovery was noted during a period of 6 to 8 months, with the normalization of ankle function by 4-months. This case exemplifies a rare presentation of disseminated osteoarticular multidrug-resistant tuberculosis in an immunocompetent adult.