Lumbar paradiscal lytic lesion due to vertebral tuberculosis (Pott's disease) in a young immunocompetent patient: case report.

Abstract

Introduction: Spinal infections may present insidiously in immunocompetent young adults with normal chest radiography, delaying recognition and treatment. Case report: 23-year-old immunocompetent male with six months of progressive low back pain and no systemic symptoms. MR demonstrated L3 marrow edema, paradiscal involvement with anterior subligamentous spread, and a rim-enhancing paravertebral/psoas abscess on fat-suppressed post-contrast T1-weighted imaging. Axial sequences clearly delineated the collection, and diffusion-weighted imaging showed high signal intensity with reduced ADC in the paravertebral/psoas collection (mean ADC ≈ 0.61 × 10^-3 mm²/s), consistent with restricted diffusion. CT confirmed paradiscal lysis with cortical breach. Histopathology revealed chronic granulomatous inflammation with caseous necrosis, and Xpert MTB/RIF detected Mycobacterium tuberculosis with rifampicin susceptibility. Clinical relevance: This case highlights the diagnostic challenge of vertebral tuberculosis in immunocompetent patients without pulmonary findings and underscores the value of integrating advanced imaging, diffusion metrics, histopathology, and molecular testing for timely confirmation. Early recognition of characteristic imaging patterns is critical to prevent diagnostic delay and potential neurological sequelae, supporting the relevance of this report for radiologists and multidisciplinary teams managing chronic lumbar lytic lesions.