DISCITIS WITH EXTENSIVE SYNDESMOPHYTES AN D MULTIFOCAL OSTEOSCLEROSISDUE TO TUBERCULOSIS

Although atypical presentations of Pott's disease are far from excepti onal in countries where tuberculosis is endemic, syndesmophyte-like os sifications are exceedingly rare. A case is reported in a 30-year-old man who was evaluated in 1983 for a ten-year history of back pain. The pain was intermittent at first but became inflammatory about one year before the evaluation. There was a weight loss of ten kilos and a tho racic hump at the level of T5-TG. The erythrocyte sedimentation rate w as 78 mm/h. Roentgenograms disclosed a wedge-shaped anterior fracture of T6, fusion of the anterior parts of the bodies of T6 and T7, and lo ss of height of the T8-T9 disk, with no geodes. A syndesmophyte-like f lowing ossification was visible from T4 to T10, with a coarse appearan ce opposite T4 and T5. On the left, the ossification extended from T4 to T10, whereas on the right it formed a bridge over T7-T8. The parasp inal structures were displaced opposite the bony focus. A computed tom ography study confirmed these abnormalities and showed foci of vertebr al osteosclerosis with no lysis, as well as displacement of the parave rtebral structures by a collection of fluid lying between the spine an d the aorta and extending to the posterior part of the left pleural ca vity. A mediastinal adenopathy was also visible. Large numbers of tube rcle bacilli were found in bronchial aspirates. The patient was succes sfully treated by antituberculous agents. Twelve months later the synd esmophytes sheathing the thoracic spine were clearly visible. The natu re of this ossification and the mechanisms by which it developed are d iscussed ill the light of a review of the few previously published cas es.