Panspinal Multifocal Non-Contiguous Tubercular Spondylodiscitis Spanning the Cervical, Thoracic, and Lumbosacral Spine with Compressive Myelopathy in a Young Immunocompetent Male — A Rare Case Managed with Medical Therapy and Comprehensive Rehabilita

Introduction: TB spondylitis is an extrapulmonary form of the disease, known eponymously as Pott’s disease in recognition of the British physician, Dr. Percivall Pott, who first described the condition in 1779, occurs in 1%-5% of TB patients. It is the most common form of skeletal tuberculosis and accounts for nearly half of all extrapulmonary skeletal TB cases worldwide. When diagnosed early, TB spondylitis can be treated conservatively in an effort to avoid complications. However, late diagnosis often requires both medical and surgical interventions to manage progressive bone destruction, spine instability, kyphosis, and spinal cord damage. Case Presentation: We report the case of Ariyan, a 20-year-old immunocompetent male who presented with progressive back pain, loss of appetite and evening rise of temperature for six months of duration. Whole-spine MRI with contrast performed on 15 May 2025, revealed tubercular spondylodiscitis at three anatomically separate spinal regions: C5–C7 with pre- and para-vertebral epidural abscess causing cervical compressive myelopathy; D1–D10 with extensive paraspinal soft tissue collection and thoracic cord compression; and L4–S2 with epidural abscess and lumbosacral nerve root compression. Cord signal change on T2-weighted imaging was noted at the D12–L1 junction. QuantiFERON-TB Gold Plus (IGRA) Result: POSITIVE, CT guided FNAC showing epithelioid cell clusters with lymphocytic infiltrate and necrotic background, consistent with tuberculous granulomatous inflammation— confirming TB infection. Outcome: The treatment has been initiated with the conventional four-drug antitubercular therapy comprising Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol (HRZE) to help his body fight this infection in the best way. His neurological progress is closely monitored at regular intervals with the help of MRI scans to monitor how his spine is healing from within. In addition to this, he has also started his rehabilitation journey to help him regain his movements, strength, and activities that were taken away from him. Conclusion: This case stands as one of the most extensive presentations of multifocal spinal tuberculosis seen in recent literature. What makes it truly remarkable is not just the sheer span of spinal involvement, stretching from the cervicothoracic junction all the way down to the sacrum, but the fact that it unfolded in a young man who was otherwise healthy, with a fully intact immune system and no prior history of tuberculosis. he was, by every measure, an unlikely candidate for a disease of this magnitude. Yet his case serves as a powerful reminder that tuberculosis can defy expectation, strike without warning, and devastate silently before it is ever named. It compels us to think beyond the obvious, to image the whole spine, not just the symptomatic segment, and above all, to diagnose early, because in spinal tuberculosis, every delay carries the risk of neurological damage that may never fully reverse. Medicine Today 2026, Vol.38 (2): 332-335