Le mal de pott sous occipital révélé par un abcès rétro pharyngien a propos d’un cas
Introduction : Pott's disease is the most frequent localisation of osteo-articular tuberculosis. The suboccipital localisation remains rare. Case report : A 12-years old boy, admitted for cervicalgy and dysphagia. His clinical exam revealed a swelling of posterior pharyngeal wall associated with a basicervical tumefaction fistulased to the skin. Cervical spine MRI and cervico-thoracic tomodensitometry show a retro-pharyngeal collection associated with necrosed mediastinal adenopathies and apical pulmonar retractile lesion. The patient underwent, in emergency, an incision of the retro-pharyngeal abscess. The biological assessment revealed an inflommatory syndrom. A tuberculine intra dermo-reaction was negative whereas the BK research were positive. The diagnosis of suboccipital Pott's disease associated with pulmonar tuberculosis was done. The anti-tuberculosis drug was mentained for 11 months with a good recovery. The follow-up was 6 years. Discussion : The sub occipital pain Pott localisation was rare. The cervicalgy was the important clinical sign of consultation. Whearas, the dysphagia and retro-pharyngeal abscess could be revealing. The MRI was necessary for an early diagnosis. The diagnosis confirmation was made by the presence of Mycobacterium Koch in the pottic lesion. The treatment was based on the anti-tuberculosis drugs for a period of 11 months completed with an orthopedic or surgical stabilisation of cervical occipital jonction.
Keywords : Pott’s disease, tuberculosis, cervical spine, MRI, Mycobacterium Koch.