Pott Disease (Tuberculous [TB] Spondylitis) Differential Diagnoses

Updated: Feb 18, 2022
  • Author: Jose A Hidalgo, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Diagnostic Considerations

Many persons with Pott disease (62%-90% of patients in reported series [18, 19] ) have no evidence of extraspinal tuberculosis. Information from imaging studies, microbiology, and anatomic pathology should help to establish the diagnosis. Etiological diagnosis with microbiologic recovery of organisms is difficult in limited-resources settings and requires invasive procedures.

The diagnosis of tuberculous spondylitis should be investigated if strong clinical suspicion exists, even if suggestive pulmonary radiology findings are absent. [27]

Other features suggestive of tuberculosis include the following:

  • Positive tuberculin skin test (purified protein derivative [PPD]) result

  • Chest radiograph that shows apical scarring, infiltrates, or cavitary disease

  • Presence of risk factors for tuberculosis

Spinal tuberculosis should always be suspected when radiographs demonstrate a destructive spinal process.

Conditions to consider in the differential diagnosis of Pott disease include the following:

  • Spinal tumors

  • Mycobacterium kansasii

  • Nocardiosis

  • Paracoccidioidomycosis

  • Septic arthritis

  • Spinal cord abscess

  • Other granulomatous processes, particularly brucellosis [28]

Differential Diagnoses