Pott’s Disease as the Initial Presentation of Tuberculosis: Diagnostic Challenges and Radiological Findings in District-Level Care

Background Spinal tuberculosis (Pott’s disease) is a rare form of extra-pulmonary TB, often presenting with non-specific 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 : We report the case of a previously healthy 28-year-old female who presented with a three-week history of progressive lower back pain, fatigue, and functional impairment, but without pulmonary symptoms or known TB contacts. Examination revealed a lumbar spinal bulge, localised kyphosis, and tenderness. Laboratory studies showed elevated inflammatory markers (CRP 157 mg/L, WCC 11.2 × 10⁹/L). Lumbar spine X-ray showed a wedge-shaped compression fracture at L3 with focal kyphotic deformity. Microbiological confirmation was not possible due to lack of advanced diagnostic facilities. After multidisciplinary consultation, empirical anti-tuberculous therapy was started. Conclusion This case illustrates the diagnostic complexity of spinal TB in resource-limited settings and underscores the value of clinical suspicion, multidisciplinary collaboration, and careful radiological assessment when advanced diagnostics are unavailable. Spinal TB should be considered in patients with chronic back pain and vertebral changes, even in the absence of classic TB symptoms. Early recognition and treatment are critical to prevent complications.