Background
Extrapulmonary and pulmonary mycobacterium tuberculosis (MTB) are rarely seen in patients with cystic fibrosis (CF). No cases of Pott's disease have been reported in CF.
Case report
We describe a female adolescent with cystic fibrosis who is 13 years old and one of three siblings who also have the disease. Fecal elastase was normal. She was diagnosed in early infancy as screening based on a positive family history of CF. She had the BCG vaccine shortly after birth. The patient rarely had acute chest exacerbations despite not taking her medications and regular airway clearance. She experienced severe back pain for two months and reported localized discomfort at the spinous process of the lumbar spine, but no sphincter dysfunction or neurological impairments. Staphylococcus aureus grew in her sputum culture. Her prior MTB polymerase chain assays and sputum cultures were all negative. An urgent magnetic resonance imaging was performed and revealed spondylodiskitis, associated with an intraspinal abscess formation, thecal sac compression, and peri vertebral collection associated with the extension into the psoas muscle. There were no pulmonary symptoms discovered. Force expiratory flow volume showed a mild to moderate restrictive pattern. There was evidence of both a positive family history of TB and a positive quantiferon result. The patient's condition significantly improved after getting oral steroids and anti-tuberculous medications.
Conclusion:
This case report serves as a reminder that extrapulmonary MTB can affect people with cystic fibrosis and might have catastrophic consequences if detection and treatment are delayed.