Presumed tuberculosis spondylitis with sternal involvement

Tuberculosis Spondylitis, also known as Pott's Disease, is an extrapulmonary form of tuberculosis (TB) that affects the spine. Sternal involvement is rare and accounts for only 0.3 % of cases. Its presentation is usually insidious in onset with many patients having little to no symptoms. Additionally, microbiological and histological results are inconsistent due to paucibacillary load from vertebral biopsies making definitive diagnosis challenging. Due to difficulty obtaining a diagnostic sample, a significant amount of TB spondylitis cases are presumed TB cases from improving clinical symptoms after empiric treatment as was our case. The purpose of this case report is to emphasize the diagnostic challenges of TB as well as present imaging findings over the course of two years with progressive involvement of the spine and sternum. Thus, here we report a case of presumed spinal tuberculosis affecting not only multiple levels of the spinal column but also the sternum in an immunocompetent United States born citizen with an indolent clinical course.