Diagnostic Considerations in Cervical Pott Disease: When to Investigate Recurrent Cervicocephalic Pain

Abstract Isolated involvement of upper cervical and craniovertebral junction is an extremely rare location of tuberculosis infection, but might lead to severe consequences if the diagnosis is delayed or misread. The authors present a case of cervical Pott’s disease with atlantoaxial and epistropheus erosion in a 28-year-old Indian man with no other comorbidities who came to the emergency department several times for a worsening neck pain that had been present for about 8 months, and mild dysphagia. A total body CT scan and a cervical-dorsal MRI were performed, showing erosive phenomena of the left lateral portion of the atlas and of the odontoid process of the axis. An intraoral biopsy through the posterior pharyngeal wall to the affected site was performed, without the aid of external or endoscopic approaches. Both the biopsy and the microbiological sample showed the presence of mycobacterium tuberculosis complex infection. The patient was treated with standard anti-tubercular therapy and at 6-month follow-up he showed clinical and radiological improvements.