LAUSR

BACKGROUND The tuberculosis is characterised by cold abscess which classically lacks the usual signs and symptoms of inflammation. This case report highlights atypical presentation of tuberculous cold abscess in the form of appearance of massive swelling in back overnight after a blunt trauma, mimicking post traumatic hematoma. CASE DESCRIPTION 32-year old male patient came to our outpatient department with a sudden swelling over right side of upper back(25cm×8cm×8cm) and loin(10cm×4cm×4cm) following a fall from 5-feet height the previous night. The possible differential diagnosis of a traumatic pathology, complicated by a bleeding disorder, resulting in massive hematoma was initially made. However, haematological investigations were within normal limits. MRI suggested an anterior subligamentous abscess at C7-T1 level tracking through paraspinal muscles and communicating with subcutaneous abscess and at L3 level, paraspinal abscess tracking to the subcutaneous plane. There was no cord-compression or signal changes in the cord. Both the abscesses were pigtailed in antigravity fashion and material was sent for culture, which proved to be tuberculosis. Patient was treated with antituberculosis treatment for 18-months and improved over the course with complete resolution of symptoms. At 4-year follow up, the patient is asymptomatic with no evidence of recurrence. CONCLUSION Appearance of massive swelling overnight in the patients with cold abscess has not been described in literature. While evaluating an atypical presentation such as sudden post traumatic swelling over thoraco-lumbar area, the clinician should keep a differential diagnosis of tuberculous abscess and investigate clinico-radiologically to rule out tuberculosis, especially in developing countries.