Rakotoson J L, Rakotomizao J R, Andrianarisoa A C F
Unité de soins, de formations et de recherches de pneumologie, CHU d'Antananarivo, lot III H 37, Ouest Ambohijanahary, Antananarivo 101, Madagascar.
Rev Pneumol Clin. 2010 Dec;66(6):359-62. doi: 10.1016/j.pneumo.2009.10.007. Epub 2010 Feb 12.
Pott's disease, or tuberculosis of the spine, is the most common osteoarticular tuberculosis. Among them, dorsolumbar impairment is predominant. The authors report the case of a patient with a huge cold lumbar abscess associated with Pott's disease. The patient is a 32-year-old man presenting dorsolumbar tumefaction associated with an alteration in his general condition and fever for three months. Treatment by "traditional healers" did not provide any improvement. He consulted for mild lumbar pain triggered by fatigue appearing one week before and after the failure of the traditional practitioner. The clinical examination found a temperature of 38.5°C, cachexia, mild lumber kyphosis and impressive, soft, painless and non inflammatory dorsolumbar bruised tumefaction, 40 cm high, 15 cm wide and 7 cm deep. He did not present any neurological signs. The dorsolumbar X-ray of the spine revealed a lesion associated with Pott's disease in the first and second lumbar vertebrae with pinching of the disc, punched-out lesions and osteocondensation. The ultrasound examination of the soft tissue revealed the presence of a laterovertebral collection of fluid diffusing in the subcutaneous region. The psoas major and the paravertebral muscles were not affected. A scan or MRI of the spine was not carried out. Examination of the tissue sample and drainage of the abscess confirmed the tubercular origin. Treatment with tuberculostatic drugs for 12 months associated with immobilisation resulted in a cure with sequelae of mild kyphoscoliosis vertebral statics.
波特氏病，即脊柱结核，是最常见的骨关节结核。其中，胸腰段损害最为常见。作者报告了一例伴有巨大寒性腰大肌脓肿的波特氏病患者。患者为一名32岁男性，出现胸腰段肿胀，伴有全身状况改变和发热三个月。“传统治疗师”的治疗未见任何改善。他因在传统治疗师治疗失败前后一周出现的疲劳引发的轻度腰痛前来就诊。临床检查发现体温38.5°C，恶病质，轻度腰椎后凸，以及令人印象深刻的、柔软、无痛且无炎症的胸腰段瘀斑性肿胀，高40厘米，宽15厘米，深7厘米。他未出现任何神经体征。脊柱胸腰段X线显示第一和第二腰椎有与波特氏病相关的病变，伴有椎间盘受压、骨质缺损性病变和骨质硬化。软组织超声检查显示存在一个向外侧椎体的液体积聚，在皮下区域扩散。腰大肌和椎旁肌未受影响。未进行脊柱扫描或MRI检查。组织样本检查和脓肿引流证实为结核起源。使用抗结核药物治疗12个月并辅以固定，治愈后遗留轻度脊柱后凸侧弯畸形的后遗症。
