Pott luck: An unexpected cause of back pain

Abstract Background Bovine Tuberculosis (bTB) is an infectious disease of animals caused by Mycobacterium bovis (M. Bovis).1 It is a notifiable disease in Ireland.1 Transmission to humans is most commonly through eating or drinking contaminated unpasteurized dairy products.2 In Ireland, a national programme to eradicate bTB has been in place since the late 1950s. However, the bTB situation in Ireland has disimproved in recent years.3 Of note, the herd incidence was 5% in 2024 compared to 3.3% in 2015.3 An average of 6 cases of zoonotic TB in humans were reported annually in Ireland between 2006 and 2018.4 Given the ongoing risk of transmission to humans, bTB remains an important public health risk. Methods We present a case study of confirmed bTB disease. Results A 81-year-old cattle farmer was admitted from clinic with a two-year history of gradual onset back pain. The patient had an excellent functional baseline and was actively working on his farm prior to developing this debilitating pain. He also reported weight loss and night sweats over a number of months. On admission, he was febrile and his inflammatory blood markers were elevated. Peripheral blood cultures from multiple different sites all tested negative. An echocardiogram demonstrated no vegetations. Magnetic resonance imaging (MRI) of his lumbar spine demonstrated osteodiscitis of L3 and L4 with a paraspinal/psoas abscess. Aspirate from the psoas abscess tested positive for M. Bovis. He was treated with rifampicin, isoniazid and ethambutol. The patient reported a confirmed case of bTB within his herd 2 years prior to presentation in our clinic. His herd were Irish bred and the diagnosis was made on annual testing. He denied any recent exposure to unpasteurized dairy products. Conclusion This case demonstrates that bTB remains a risk in Ireland and should be considered as a differential diagnosis when treating patients with farming occupations.