A Case of Pott’s Disease Complicated by Tuberculous Meningitis and Psoas Abscess Diagnosed by Computed Tomography-Guided Percutaneous Drainage

Tuberculosis (TB) is an infectious disease caused by <i>Mycobacterium tuberculosis</i> (MTB). Disseminated TB can cause various types of complications. Extrapulmonary TB includes TB meningitis, abdominal TB, skeletal TB, Pott's disease (spine), scrofula, and genitourinary TB. In particular, TB meningitis is a lethal complication of TB with a high mortality rate. The patient was an 84-year-old Japanese man with a history of tuberculous pleurisy during childhood who presented with fever and altered mental status. Eight months prior, the patient was diagnosed with a urinary tract infection and treated with levofloxacin, but further investigation showed spondylitis. Although the causative microorganism was not identified as levofloxacin likely masked it, he was treated with linezolid and rifampicin for six weeks for the empiric diagnosis of bacterial pyogenic spondylitis; both medications are also antituberculous agents. At this visit, abdominal computed tomography (CT) revealed a left psoas abscess with calcification, and cerebral magnetic resonance imaging revealed multiple nodules with target signs. Cerebrospinal fluid (CSF) findings were consistent with TB meningitis, though the TB polymerase chain reaction, culture, and CSF cytology were all negative. He underwent CT-guided percutaneous drainage for the psoas abscess, and MTB was finally identified. Although he was treated with antituberculous agents including rifampicin, ethambutol, and isoniazid, the patient died seven months after admission as a result of the debilitating effects of tuberculous meningitis. In our case, we should have tried to identify the causative organism in the diagnosis of pyogenic spondylitis. Especially in patients with a history of TB, the possibility of TB should always be considered. In addition, the use of antituberculous drugs may mask the presentation; therefore, biopsy or CT-guided drainage, as used in this case, should be considered for diagnostic accuracy.