Naga College Foundation

Naga City

Case Analysis
“Pott’s Disease”

By: Michael Adrian A. Peñaflor

BSN – 4G

INTRODUCTION
Tuberculosis (TB) of the spine also known as Potts disease, Pott’s Caries,
David's disease, Tuberculosis spondylitis and Pott's curvature, is the most
common site of bone infection in TB. The lower thoracic and upper lumbar
vertebrae are the areas of the spine most often affected. The original name
was formed after Percivall Pott, a London surgeon, who first studied the
disease. When he died, Patrick David was the one who continued his work.
Pott’s disease results from haematogenous spread of tuberculosis
(mycobacterium tuberculosis) from other sites. The infection then spreads
from two adjacent vertebrae into the adjoining disc space. If only one
vertebra is affected, the disc is normal,but if two are involved the
intervertebral disc, which is avascular, cannot receive nutrients and
collapses. The disc tissue dies and is broken down by caseation, leading to
vertebral narrowing and eventually to vertebral collapse and spinal damage.
A dry soft tissue mass often forms and superinfection is rare.
The disease progresses slowly. Signs and symptoms include: back
pain, fever, night sweats, anorexia, weight loss, and easy fatigability.
Diagnosis is based on: blood tests - elevated ESR , skin tests
,radiographs of the spine , bone scan ,CT of the spine , and bone biopsy.
Gibbus formation is the pathognomonic sign of this disease.
A person with Pott's disease often develops kyphosis, which results in a
hunchback. This is often referred to as Pott’s curvature. In some cases, a
person with Pott's disease may also develop paralysis, referred to as Pott’s
paraplegia, when the spinal nerves become affected by the curvature.
A person who has been diagnosed with Pott's disease may be treated
through a variety of options. He or she may utilize analgesics or
antituberculosis drugs to get the infection under control. It may also be
necessary to immobilize the area of the spine affected by the disease, or the
person may need to undergo surgery in order to drain any abscesses that
may have formed or to stabilize the spine.
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

ASSESSMENT

Data of the Patient:

• Name: Mr. X
• Adress: Sta. Cruz Ratay, Calabanga Cam. Sur
 • Gender: M
• Civil status: Married
• Birthdate: February 6, 1967
• Age: 42
• Nationality: Filipino
• Religion: Catholic
• Date of Admission: August 16, 2009
Time: 5:30pm
• Admitting Physician: Edlyn D. Borais MD
• Admitting Diagnosis: T/C Demyelinating Dse. Vs Pott’s Dse.

Nursing Hx:

• Cc: Numbness of Lower Extremities

• Brief Hx: 1 month PTA – Recurrent headache and accompanying
Blurring of vision
Patient is not known to be hypertensive

1 week PTA – Patient ha been complaining of numbness of lower

extremities but still ambulatory.

• (-)fever
• (+)nausea
• BP was from 90/60 – 100/90

1 day PTA – Patient had foot drop and unable to ambulate

• Patient Hx:
(-)DM
(-)PTB
• Family Hx:
(+)Ca – Brother
(-)DM
• Social Hx:
Smoker > 1 pack/day
Occational Alcohol drinker

PATHOPHYSIOLOGY

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receive nutrients and
and easy fatigability. collapse LABORATORY RESULTS

Aug. 16, 2009

• Urinalysis
Physical
Examination:
 Color
:

yellow
 Transparency: Cloudy9
 pH: 6.0
 Specific Gravity: 1.020

Chemical Examination:

 Glucose: (-)Neg
  Albumin: (-)Neg

Microscopic Examination:

 Pus cells: 0-2

 RBC: 0-1
 Epithelial cells: few

• Chest X-ray Result

Examination: Chest, T-L-S AP/L

Findings:
There are no active parenchymal infiltrates
Heart is normal in size
The right CPS is blunted
Bony thorax is unremarkable
Impression:
Normal chest study

Thoracic and Lumbosacral AP/LAT

Findings:
There are osteophytes in the anterior lumbar bodies
The vertebral height and disc spaces are intact. The pedicles are
preserved
There is no fracture or destructive bone lesion seen
Impression:
Spondylosis deformans of the spine
• BUN and Creatinine Test
Sample Fluid: Serum

Test Name Code Results

Blood Urea Nitrogen BUN 3.3

Creatinine CREA 76
Sodium Na 140
Potassium K 4.1

• Hematology
Test Name Result Reference
WBC Count 5.7 4-10
RBC Count 5.48 4.2-6.3
 Hemoglobin 152 120-180
Hematocrit 0.46 0.37-0.54
Platelet Count 379 150-450
MCV 84 80-100
MCH 27.8 27-33
MCHC 330 320-360
• Lymphocyte(P) 31.9 30-60
• Monocyte 8.5 3-9
• Granulocyte 59.6 20-65
RDW 13.50 13-16
MPV 5.90 7.1-9.5
PDW 11.20 10-18
• Lymphocyte(a) 1.80 1.2-3.2
• Monocyte 0.40 0.2-0.8
• Granulocyte 3.50 1.2-6.8

Discharge Plan

P- atient should be reminded to attend check-ups at the nearest…

O- rthopedic center

T- reatment should be taken in a…

T- imely manner
S- ight any symptoms other than the usual and report it to the physician

10 rights of drug administration

• Right Medication
• Right Patient
• Right Dosage
• Right Route
• Right Time
• Right Documentation
• Right Assessment
• Right to Education & Information
• Right to Refuse
• Right Evaluation