Pre-extensively drug-resistant tuberculosis of the spine in a previously healthy young adult: case report

Spinal tuberculosis (TB), previously known as Pott’s disease, is the most common bone infection caused by Mycobacterium tuberculosis. The diagnosis of spinal TB is based on clinical, radiographic, microbiological, and histological findings. Its indolent nature, subacute progression, paucibacillary state, and difficulties in obtaining adequate samples often result in delayed diagnosis. The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB has posed significant challenges in the management of TB infections. Here, we present a case of pre-XDR tuberculosis of the spine in a 32-year-old Indian male, managed with surgical intervention, because of neurological deficits, and a second-line antituberculosis drug regimen, guided by antimicrobial susceptibility testing, including bedaquiline, linezolid, amikacin, cycloserine, and ethionamide. This case highlights the challenges associated with the diagnosis and treatment of pre-XDR spinal tuberculosis.