Potts disease

 Is a spine infection associated with tuberculosis that is characterized

by bone destruction, fracture, and collapse of the vertebrae, resulting
in kyphotic deformity.

 Is the presentation of the extra-pulmonary tuberculosis arthritis of the

intervertebral joints

 Also called tuberculosis spondylitis, tuberculous

spondyloarthropathy, spinal TB, musculoskeletal tuberculosis

 The causative agent is Mycobacterium Tubercule

 Particularly the lower thoracic and the upper lumbar regions are
affected.

 Commonly localized in the thoracic 11 and thoracic 12.

 The original name was formed after Percivall Potts a London

surgeon.

 Patient with BCG has 80% immunity.

Pathognomonic Sign: Gibbous Formation

Signs and Symptoms:

Back Pain

Fever

Night Sweating

Anorexia

Weight Loss

Spinal mass

Nursing History
1. Personal Data

Name: Rafonzel De Leon

Age: 4y/o
 Sex: Female

Address: Marulas, Kawit, Cavite City

Occupation: N/A

Religion: Roman Catholic

Date and Time of admission: June 27, 2010 3:00am

2. Chief Complaint

Fever and Back pain

3. History of Present illness

4 months before hospitalization the patient felled from the stairs.

The patient’s mother brought her to a “manghihilot”.

2 weeks before hospitalization the patient’s mother have seen a

mass at the patient’s back, the patient had fever and accompanied
with back pain. The mother decided to go to the doctor for
consultation.

1 day before hospitalization the patient’s mother went to the

hospital and was referred to Phil. Orthopedic Center. The patient was
admitted at children’s ward and scheduled for CBC and x-ray of the
thoracolumbar spine.
 4. Past Medical History

The patient’s mother always consults “Manghihilot” when her

daughter is sick. The mother has lack of interest in going to health
center to seek medical consultation when her daughter is sick.

5. Family Medical History

The mother and father of the patient self-medicates when there are
sick, the mother said that there family has never been hospitalized.
The father works as a construction worker, smoke cigarettes at least 3-
4 sticks a day. The mother stays at home to take care of her 2
children.

Pathophysiology
Pulmonary Tuberculosis

Spread of Mycobacterium Tubercule in

the T7-T9 of the spine

Extra-pulmonary Tuberculosis

The infection spreads from

Disc tissue dies and
intervertebral disc
Backbroken
Pain, Fever,
down byNight
Sweats,
Vertebral
Vertebral
Potts’
Spinal Spinal mass
Disease
Damage
Narrowing
Collapse
caseation
 Pus formation between the
intervertebral disc

DIAGNOSIS

• ‡ blood tests

- elevated erythrocyte

• sedimentation rate

• ‡ tuberculin skin test

• ‡ radiographs of the spine

• ‡ bone scan

• ‡ CT of the spine

• ‡bone biopsy
 • ‡ MRI

Laboratory / Diagnostic Examinations

Blood Chemistry Normal Value Result Findings

Component:

-Hemoglobin 110-150 125 g /L Normal

mass g/L(female)
16.90 g/L May indicate infection
-Leucocyte count 4.5-10 x 10 g/L

Differential
count: 0.45 Normal
0.50-0.70
-Segmenters 0.42 May indicate infection
0.20-0.40
-Lymphocyctes 0.08 May indicate infection
0.00-0.07
-Monocytes 0.05 Normal
0.00-0.05
-Eosinophils 532 x May indicate
150-400 x 10 /L
9
109/L inflammatory disease
-Platelet count

Blood Chemistry Normal Value Result Findings

Component:

-Hemoglobin 110-150 129 g/L Normal

mass g/L(female)
0.40 Normal
-Hematocrit 0.37-0.54
13.6 x 10 May indicate infection
-Leucocyte count 4.5-10 x 10 g/L g/L

Differential
count: Normal
0.50-0.70 0.45
-Segmenters May indicate infection
0.20-0.40 0.50
-Lymphocyctes Normal
0.00-0.07 0.01
-Monocytes Normal
0.00-0.05 0.04
-Eosinophils Normal
150-400 x 10 /L
9
375 x
-Platelet count 109/L

Urinalysis Normal Value Result Findings

Electrolytes:

Sodium 135-148 mmol/L 139.7 mmol/L Normal

Potassium 3.5-5.3 mmol/L 3.98 mmol/L Normal

Chloride 98-107 mmol/L 101.7 mmol/L Normal

 Urinalysis Normal Value Result Findings

Color Straw to Dark Light yellow Normal

yellow
Transparency Hazy Normal
Slightly Hazy
Specific Gravity 1.003 Normal
1.002-1.006
Reaction Acidic

X-ray of the Thoracolumbar spine

• Impression: Pneumonitis, both lower lung zone with lyphadenopathies

• Consolidation vs. Extension of paravertebral abscess, right lower lung

zone

• Potts disease, as described, T6-T11

CT scan of the Thoracic spine

• Impression: Findings as consistent with Potts disease T8-T9 with

pulmonary extension as described

Management

Since Pott's disease is caused by a bacterial infection, prevention is possible

through proper control. The best method for preventing the disease is
reduce or eliminate the spread of tuberculosis. In addition, testing for
tuberculosis is an important preventative measure, as those who are
positive for purified protein derivative (PPD) can take medication to prevent
tuberculosis from forming. A tuberculin skin test is the most common
method used to screen for tuberculosis, though blood tests , bone scans,
bone biopsies, and radiographs may also be used to confirm the disease.