Pott’s Disease in a Young Homozygous Sickle Cell Patient at the Hospital Center of Soavinandriana, Antananarivo

Background: Spinal tuberculosis, also known as Pott disease, is a major cause of chronic spondylodiscitis. Diagnosis may be delayed when symptoms are nonspecific, imaging mimics malignancy, or bone manifestations of sickle cell disease coexist. In such settings, vertebral biopsy and histopathological examinations are essential.Case Presentation: We report the case of a 21-year-old man with known homozygous sickle cell disease, referred for chronic low back pain of three years’ duration and multiple lumbar vertebral lytic lesions. Clinical examination revealed lumbar kyphotic deformity and paravertebral contracture without neurological deficits. Imaging revealed L2–L3 destructive lesions and extensive lytic lesions that were initially suspected to be metastatic lesions. Bone marrow examination revealed a regenerative inflammatory marrow pattern consistent with chronic sickle cell disease, without evidence of malignant infiltration. Vertebral biopsy revealed epithelioid and giant cell granulomas associated with caseous necrosis, supporting the diagnosis of spinal tuberculosis. Clinical improvement was achieved with thoracolumbar bracing and antituberculosis treatment. Conclusion: This case highlights the decisive role of histopathology in diagnosing Pott’s disease in a patient with sickle cell disease and lytic spinal lesions. Granulomatous inflammation with caseous necrosis strongly suggests tuberculosis but must be interpreted in conjunction with clinical and radiological findings.