Pott’s disease as the initial presentation of tuberculosis: diagnostic challenges and radiological findings in district-level care—a case report

BACKGROUND: Spinal tuberculosis (Pott's disease) is a rare form of extra-pulmonary tuberculosis, often presenting with nonspecific symptoms and posing diagnostic challenges, especially in resource-limited settings. While microbiological confirmation is the gold standard, it is often unavailable in district hospitals. CASE PRESENTATION: /L). A lateral lumbar spine X-ray demonstrated a wedge-shaped compression fracture at L3 with focal kyphotic deformity and endplate irregularity. Microbiological confirmation was not possible at the district level owing to a lack of advanced diagnostics. After multidisciplinary consultation, empirical antituberculous therapy was initiated per national guidelines. Subsequent computed tomography at a tertiary center strongly supported tuberculous spondylodiscitis, and the patient has shown marked clinical improvement on conservative management. CONCLUSION: This case illustrates the diagnostic complexity of spinal tuberculosis in district-level care and underscores the value of clinical suspicion, multidisciplinary collaboration, and careful assessment of plain radiographs when advanced diagnostics are unavailable. Clinicians should consider spinal tuberculosis in patients with chronic back pain and vertebral changes, even in the absence of classic tuberculosis symptoms. Early recognition and treatment are critical to prevent neurological compromise and deformity progression.