Bilateral extensive tubercular iliopsoas abscess: An uncommon manifestation of Pott's spine

Bilateral iliopsoas abscess is an uncommon presentation of Pott's spine. We recently cared for a young, immunocompetent male who presented with a right paravertebral swelling. He had been on antitubercular therapy (ATT) for 6 months for pulmonary tuberculosis. On computerized tomography (CT), the patient was found to have Pott's spine as the primary pathology with extensive iliopsoas abscesses bilaterally. The aspirate from the swelling grew Mycobacterium tuberculosis, which was resistant to isoniazid and rifampicin. He was then started on appropriate drugs according to sensitivity reports. Our patient was a rare case of a young, immunocompetent male who presented with large bilateral psoas involvement due to Pott's spine. This was not associated with any neurological deficit. The organisms were multidrug-resistant, even though the pulmonary lesions had resolved after being on ATT for 6 months. To conclude, for any tubercular patient presenting with paravertebral abscess or back pain, Pott's spine should be considered among the differential diagnoses, especially in endemic regions. Tubercular culture and sensitivity should be done in all such cases due to the widespread prevalence of drug-resistant forms.