Unusual co-presentation of cervical lordosis reversal and bilateral psoas abscess in a paediatric patient with spinal tuberculosis

Abstract BACKGROUND Spinal tuberculosis in children is uncommon and often remains undiagnosed due to vague symptoms. The coexistence of cervical lordosis reversal and bilateral psoas abscess is extremely rare and indicates advanced systemic disease. Early recognition is vital to prevent neurological impairment and spinal deformity. CASE PRESENTATION A 16-year-old female presented with progressive lower limb weakness, severe back pain, and chronic cough. Imaging revealed Pott’s disease affecting L2–L3 vertebrae, bilateral psoas abscesses, and reversal of cervical lordosis. She also had pulmonary tuberculosis, severe anemia, electrolyte imbalance, and developed bradycardia requiring ICU care. MRI confirmed vertebral destruction and epidural collection. Anti-tubercular therapy was initiated based on ICMR guidelines along with supportive management. CONCLUSION This rare presentation highlights the importance of prompt imaging, early suspicion, and multidisciplinary management in pediatric spinal tuberculosis. Cervical lordosis reversal with psoas abscess signifies severe disease progression. Timely anti-tubercular treatment and supportive care can prevent long-term disability and improve recovery. The patient achieved near-complete recovery with anti-tubercular therapy and supportive care.