General Medicine

2012, vol. 13, no. 2, p. 110-112.

Case Report

Potts Disease and Cold Abscesses

Daisuke Kurai MD, Takeshi Saraya MD, Manabu Ishida MD,

Akira Nakajima MD, Yukari Ogawa MD, YasutakaTanaka MD,
Hajime Takizawa MD, PhD, Hajime Goto MD, PhD
Departments of Respiratory Medicine
Kyorin University School of Medicine

Tuberculous spondylitis, or so-called Potts disease, seems to be overlooked because of a lack of severe
inflammation in the insidious generating process and tends to cause non-specific symptoms, such as back pain, fever,
weakness, and weight loss. Diagnostic delay is common and the results can be disastrous. Discriminating between
Potts disease and other diseases, such as malignancy and pyogenic infection, is difficult. However, the inflammatory
process in Potts disease tends to spare the disk space, while that of pyogenic infection typically affects the area.
Herein, we present a patient with Potts disease who showed the characteristic clinical and radiological findings.
Key words: tuberculosis, spondylitis, Potts disease, cold abscess, back pain

CASE REPORT
A 68-year-old-woman was referred to our hospital
with persistent back pain and a 7 kg body weight loss

Figure 2-Ademonstrated tiny nodules scattered

throughout the lungs. Thereafter, sputum culture was
positive for Mycobacterium tuberculosis.

over 7 months. She had been undergoing treatment

Thoracic CTFigure 2-Band T2-weighted

for osteoporosis. She denied productive cough, fever,

magnetic resonance imagingMRI

Figure 2-C

and night sweats and had no remarkable medical

depicted a 10-cm mass, extending predominantly

history. Chest radiographsFigure 1-A and B

vertically along the anterior vertebral columnfrom

showed vertebral collapse and compression fractures

Th8-Th10). The mass had an enhanced rim, suggest-

from Th8 to Th10, accompanied by a paravertebral

ing abscess formation. These images also confirmed

mass and tiny nodules in the lungs. Laboratory

the destructive change shown in radiographs at the

investigations revealed only mild elevation of ESR; 29

Th8, Th9, and Th10 levels. We therefore diagnosed

mmhr.

Thoracic computed tomographyCT

tuberculous spondylitisPotts diseasecomplicated

Author for Correspondence : Hajime Goto MD, PhD

Departments of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo
181-8611, Japan
E-mail: h510@ks.kyorin-u.ac.jp

110

Potts Disease and Cold Abscesses

Figure 1.
PosteroanteriorFigure 1-Aand lateralFigure 1-Bchest radiographs showing a paravertebral mass, vertebral collapse and
compression fractures from Th8 to Th10, as well as numerous defined
nodules throughout the lung fields.

Figure 2.
Thoracic CTFigure 2-A and Bshowed a random distribution of tiny,
discrete nodules. Destruction of the vertebral body at the level of Th9,
as well as a huge paravertebral low density lesion with an enhanced
rim, was seen. Sagittal view of a T2-weighted MR imageFigure 2-C
showed the massmeasuring approximately 10 cmextending vertically. An enhanced rim was visible in front of three vertebral bodies
from Th8 to Th10). The intervening discs were relatively spared.

Th7/8
Th8/9
Th9/10

by paravertebral abscess and miliary tuberculosis.

back pain, but physical examination and medical

history play an important role in selecting patients,

DISCUSSION

because most do not require such expensive imaging

Back pain is a common symptom for which patients

tests. These tests should be reserved for patients that

usually visit a primary care physician. CT and MRI

have a strong clinical suggestion of underlying cancer,

are useful diagnostic tools to evaluate patients with

infection or neurological deficit. Clues to underlying

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2012, vol. 13, no. 2

disease in medical patients include patients age;

seen in Potts disease, develop slowly and exhibit little

unexplained weight loss; a history of cancer or

inflammation, even in the presence of miliary tubercu-

1,2

tuberculosis; and the duration of pain.

If underlying

diseases are expected, these imaging tests should be

losis, as in the present case. They are therefore

defined as cold abscesses.

considered.

Clinicians should always consider the possibility of

Our patient had no medical history of cancer,

Potts disease, pyogenic osteomyelitis, and bone

tuberculosis, or human immunodeficiency viral infec-

involvement associated with malignancy when they

tion and no steroid or immunosuppressant usage.

encounter patients with chronic back pain, irrespec-

However, her unexplained weight loss, age and long

tive of the presence of compression vertebral frac-

duration of back pain were sufficient to require CT

tures. The present imaging findings should remind us

and MRI, and the results proved to be typical findings

of the characteristic process by which cold abscesses

for Potts disease. It is essential to obtain a tissue

associated with Potts disease are formed.

sample from the involved area for an accurate

diagnosis and treatment when these imaging tests

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