An Unexpected Limp: A Pediatric Case of Pott’s Disease and a Literature Review

Abstract

Pott’s disease, also known as tuberculous spondylodiscitis, accounts for 50% of all forms of skeletal tuberculosis. It is rare in children, especially in low-burden TB countries. We present a case of Pott’s disease with miliary tuberculosis in a 22-month-old child. Furthermore, we provide an exploratory literature review of pediatric cases published in PubMed and Scopus between January 2000 and August 2025, including patients aged 0 to 17 years with confirmed or clinically diagnosed tuberculous spondylodiscitis. Sixty-four cases were included. Most cases (81.3%) involved children from highly endemic countries, particularly India. Median age was 10 years, with a median diagnostic delay of 141.4 days. The most common signs and symptoms were back pain (79.6%), followed by difficulty walking (68.4%). The thoracic spine was the most affected segment (60.3%). Sixty-three received anti-TB therapy, 58% required surgical intervention, and treatment led to overall clinical recovery in 96.9% of cases. Neurological deficits were reported in 46% (paresthesia) and 68.4% (motor weakness), with permanent motor sequelae in 8.1% and persistent spinal deformity (kyphosis) in 14.5%. Our case highlights the importance of considering the suspicion of tuberculous spondylodiscitis, even in low-endemic countries, to achieve early diagnosis and appropriate therapeutic management. Early MRI combined with microbiological confirmation is essential to reduce the risk of severe complications, including neurological sequelae, progressive spinal deformities, and potentially life-threatening outcomes in growing patients.