Discussion
Pott’s spine can present as abscesses or sinuses
away from the spine along the course of blood
vessels and nerves or along the facial planes. Abscess
from dorsolumbar or lumbar spine can track down
the psoas sheath to reach the iliac fossa, lumbar
triangle, or the upper thigh, even as far down as the
knee [1].
Gluteal abscess is the rarest of all presentations
of Pott’s spine. Kumar et al. reported a case of
tuberculosis of the sacrum with cauda equine
compression presenting with gluteal abscess in a
child. The cold abscess spread along the branches of
the aorta to reach the gluteal region [2]. This may be
the cause of gluteal abscess in our patient also.
Unfamiliarity with this presentation may lead to
mistaken diagnosis and inappropriate treatment.
Although Mousa described a case of Pott’s spine
presenting only as gluteal abscess, this presentation
appears to be much less common in adults than is
caries spine presenting as cold abscess in other sites
that have also been previously reported. In the case
described by Mousa [3], the patient was a
malnourished (probably immunocompromised) old
man presenting with recurrent gluteal abscess. Plain
lumbar spine radiograph showed only calcification of
the left psoas region with relatively normal vertebrae.
MRI and CT of the spine were not taken in that
patient and the location of the primary site of
Mycobacterium tuberculosis infection is unclear.
Moreover, medical records showing the initial
management of the gluteal abscess were not available
and it was a case of concomitant spine infection with
Mycobacterium tuberculosis and other pyogenic
bacteria