Tuberculosis osteoarticular en un paciente pediátrico / Osteoarticular tuberculosis in a pediatric patient

Introducción: La tuberculosis osteoarticular es una enfermedad inflamatoria crónica, muy rara con un cuadro clínico atípico y se presenta con una incidencia de 1-2 por ciento del total de los casos de tuberculosis. Objetivo: Exponer una forma de presentación poco frecuente de tuberculosis en Honduras Presentación del caso: Se trata de una niña de dos años con diagnóstico inicial de sinovitis en rodilla derecha de cinco meses de evolución y tratada con antibiótico y analgésico. Sin mejoría se presenta a emergencia con cambios inflamatorios. Se realiza rayos x de rodilla que muestran lesiones osteolíticas a nivel de rótula y cóndilo del fémur derecho. Baciloscopia de esputo y prueba de tuberculina negativas. Familiar de tercer grado positivo para tuberculosis hacía un año y medio. Por biopsia de tejido blando y óseo de rodilla derecha se establece el diagnóstico de artritis por Mycobacterium tuberculosis por estudio inmuno-histoquimico con tinción Ziehl Nielsen. Conclusiones: Es el primer informe de caso de tuberculosis osteoarticular en un paciente pediátrico descrito en Honduras. Por la larga evolución de la enfermedad, lo atípico de su clínica y su baja incidencia es difícil establecer el diagnóstico final. Fue imprescindible el estudio anatomopatológico por biopsia que permitiera esclarecer a los clínicos el diagnóstico e iniciar el tratamiento oportuno(AU)

Introduction: Osteoarticular tuberculosis is a chronic inflammatory disease, very rare, and with an atypical clinical picture and occurs with an incidence of 1-2 percent of all TB cases. Objective: Show a rare form of TB´s presentation in Honduras Case presentation: Two-year-old girl with an initial diagnosis of right knee synovitis of five months of evolution and treated with antibiotics and analgesics. Without improvement, she attends to emergencies service with inflammatory changes. Knee x-rays show osteolytic lesions at the kneecap level and the condyle of the right femur. Sputum bacilloscopy and negative tuberculin test were performed. She had a third-grade relative positive to tuberculosis a year and a half ago. A right knee soft tissue and bone biopsies confirm the diagnosis of arthritis by Mycobacterium tuberculosis by immuno-histochemical study with Ziehl Nielsen staining. Conclusions: It is the first osteoarticular TB case report in a pediatric patient described in Honduras. Because of the long evolution of the disease, the atypicalness of its clinic features and its low incidence, it is difficult to establish the final diagnosis. Anatomopathological study by biopsy was essential to clarify the diagnosis to clinicians and initiate timely treatment(AU)

Complicated lumbar tuberculous spondylodiscitis in disseminated tuberculosis, treated using a non-conventional anterior support system for hydrostatic distraction: a case report / Tratamento de espondilodiscite lombar complicada em tuberculose disseminada com sistema hidrostático de distração lombar: relato de caso

ABSTRACT Objective: To describe a case of disseminated tuberculosis affecting the lumbar spine that was treated using a non-conventional anterior support system. Background: Tuberculous spondylodiscitis is the most common and most severe form of extrapulmonary tuberculosis. Although antibiotic therapy is the most frequently used treatment, surgery is necessary in cases of neurological deficit, spinal instability, significant deformity, severe sepsis, paravertebral and epidural abscesses or in cases wherein clinical treatment has failed. A surgical procedure is also indicated when a biopsy is required. With the development of new methods for reconstruction and fixation of the spine, complete debridement of the tuberculous foci has become an increasingly common approach, but there is a lack consensus on the best technique. Methods and results: The patient suffered from disseminated tuberculosis affecting the lumbar region of the spine, with an abscess in the psoas muscle. He underwent extensive debridement via both anterior and posterior approaches, using a non-conventional anterior support system that promotes hydrostatic distraction. Conclusions: Treatment using the hydrostatic distraction system was able to reestablish both the stability and anatomy of the lumbar curve. Level of evidence IV, Case report.

RESUMO Objetivo: Descrever um caso de tuberculose disseminada afetando a coluna lombar, tratada com um sistema de suporte anterior não convencional. Contexto: Espondilodiscite tuberculosa é a forma mais comum e mais grave de tuberculose extrapulmonar. Embora o principal tratamento seja a antibioticoterapia, o tratamento cirúrgico é importante em casos de déficit neurológico, instabilidade da coluna e deformidade significativa, sepse grave, abscessos paravertebrais ou peridurais ou em casos de falha do tratamento clínico. Cirurgia também é necessária quando há necessidade de biópsia. Com o desenvolvimento de novos métodos para a reconstrução e fixação da coluna, cada vez mais se faz o debridamento completo do foco da tuberculose vertebral, mas há falta de consenso sobre a melhor técnica. Métodos e Resultados: O paciente sofria de tuberculose disseminada afetando a coluna, na região lombar, com abscesso do músculo psoas. Foi tratado com extenso debridamento pelas vias anterior e posterior, usando um sistema não convencional de suporte anterior que promove distração hidrostática. Conclusões: O tratamento com o distrator hidrostático foi capaz de restabelecer a estabilidade e a anatomia da curva lombar. Nível de evidência IV, Relato de caso.

Needle Aspiration and Cytology for Suspected Osteoarticular Tuberculosis in Children

@#Introduction: Early diagnosis of osteoarticular tuberculosis (OATB) is essential to prevent significant functional disability. There is no single test for diagnosis. Despite an array of investigations available, definitive diagnosis at early stage before starting antitubercular drugs is still a challenge. Materials and Methods: A cross sectional study was carried out between February 2016 and October 2017. All children less than 18 years of age with suspected osteoarticular tuberculosis were included. The cases were subjected to simple needle aspiration from whichever site was accessible. Multiple sample aspirations were done at site of involvement. Smears were prepared from the aspirated material. Results: Ziehl-Neelsen staining for Acid Fast Bacilli (AFB) showed deep pink red rods under light microscopy. Features suggestive of tuberculosis can be seen by May-GrünwaldGiemsa (MGG) staining. Auramine-O staining method of detecting AFB under fluorescent microscope shows the bacilli as greenish yellow slender curved rods in dark background. Fluorescent microscopy has higher sensitivity and comparable specificity. In our study, microbiological confirmation of OATB could be done in 100% cases where the lesion could be accessed for aspiration. The molecular techniques are relatively more expensive and not available everywhere. Conclusion: Meticulous search for AFB in a well stained smear using three different staining methods provides a direct evidence of infection over costly imaging especially in poor patients seen in resource limited settings.

Reporte de caso de tuberculosis osteoarticular: dificultad diagnóstica y probable infección primaria / Case report of osteoarticular tuberculosis: diagnostic difficulty and probable primary infection

Se presenta el caso de un varón de 36 años, procedente de Ancash, Perú, quien acude a un hospital de su localidad por dolor articular en rodilla derecha de tres años de evolución. No se consigue diagnosticar al paciente en dicho hospital y meses después acude al Hospital Nacional Dos de Mayo en la capital, donde posterior al hallazgo de un proceso inflamatorio granulomatoso en una biopsia ósea se inicia una evaluación y tratamiento para tuberculosis osteoarticular, diagnóstico que será posteriormente confirmado por cultivo positivo de líquido sinovial tras un tiempo de enfermedad de más de 45 meses. La presentación atípica, la ausencia de un foco primario y dificultad diagnóstica, en un país donde la tuberculosis es aún endémica, motivaron su descripción para su publicación

We report the case of a 36-year-old male from Ancash, Peru, who attended to a local hospital due to articular pain in the right knee for three years. Diagnosis was not reached in that hospital and months later he visited Hospital Nacional Dos de Mayo in the capital city, where evaluation and treatment for osteoarticular tuberculosis was started after finding a granulomatous inflammatory process in a bone biopsy. Such diagnosis was confirmed later by a positive culture of synovial fluid after a more than 45-month disease period. The atypical presentation, absence of a primary site and diagnostic difficulty of the disease in a country where tuberculosis is still endemic encouraged the publication of this case report

Osteoarticular Tuberculosis - A Study Associated with Socio Demographic Factors.

Background: Approximately 30 million people are currently affected by tuberculosis worldwide and 3% of them have skeletal involvement. Osteoarticular tuberculosis can cause significant morbidity and a high index of suspicion is needed for early diagnosis so as to avoid destruction and disability. Methods: Present study was carried out on 120 patients admitted in Sarswati Institute of Medical Sciences, Hapur. Data of all osteo tubercular patients were collected from medical record department; information was collected regarding patient’s general and medical information like age, sex, religion, occupation, areas, type of joint involvement, duration of hospital stay and associated medical problems and type of investigation and their finding were recorded and analysed. Results: This study was carried out on 120 patients in which 76 (63.3%) were Male and 44 (36.7%) were female. maximum were in the age group of between 31-40 years. The cases of rural background were higher than the urban. common osteotuberculr site was Spine 92(76.7%). Conclusion: The comments site of osteoarticular tuberculosis is the spine and the rural population were more involved in osteoarticular tuberculosis. Tuberculosis in extrapulmonary sites is more and more frequent.

Tuberculosis miliar con afectación pulmonar y articular

Se presenta un paciente de sexo masculino que consulta por dolor e impotencia funcional de cadera izquierda. Con los estudios radiográficos se decide una artrodesis coxofemoral y en el acto quirúrgico aparece una secreción con grumos blanquecinos donde se detectan bacterias positivas al Ziehl-Neelsen. La radiografía de tórax muestra un infiltrado miliar difuso en lóbulos superiores y senos costofrénicos libres. Recibe tratamiento antibacilar. El GeneXpert detecta Mycobacterium tuberculosis sin resistencia a rifampicina y en el líquido articular se aisla Mycobacterium tuberculosis utilizando el Método Automatizado Bactec MGIT TM320. El diagnóstico de tuberculosis extrapulmonar por técnicas moleculares y métodos automatizados acelera el desarrollo de micobacterias y permite confirmar la sospecha diagnóstica para una rápida y eficaz intervención terapéutica del paciente.

A male patient comes and consulted for pain and functional impotence of the left hip. With radiographic studies, a hip arthrodesis is decided during surgery and a discharge appears whitish lumps presenting a report Ziehl Neelsen Positive (+). The x- ray shows a diffuse miliary infiltrates in the upper lobes and free costophrenic breasts. He received Antibaciliar treatment. The GeneXpert detects Mycobacterium tuberculosis and rifampin resistance without in joint fluid is isolated Mycobacterium tuberculosis using the automated BACTEC MGIT TM320. The diagnosis of extrapulmonary tuberculosis by molecular techniques and automated methods accelerates the development of mycobacteria and confirm what has been suspected .The diagnosis allows a quick and effective therapeutic intervention.

Patterns of Abscesses of Soft Tissue in Spinal Tuberculosis: Frequency, Topography and Therapeutic Means of 311 Cases Observed in Abidjan (Ivory Coast).

Background: The research of soft tissue abscesses in spinal tuberculosis is important and can help in the diagnosis of certainty. These abscesses also have a prognostic and therapeutic interest. The aim of this study is to determine the frequency, topography and the therapeutic means of the abscesses of soft tissue in spinal tuberculosis. Methodology: This descriptive retrospective study covered 311 cases of patients (167 men and 144 women, age range 4-88 years) with soft tissue abscesses on spinal tuberculosis, detected by imaging. The patients have been selected in the rheumatology department of the University Hospital Center of Cocody in Abidjan from January 2003 to December 2013. We were interested to epidemiological, topographical and therapeutic data. Fishers exact test was used to test the significance of association between different variables. Level of significance was set at 0.05. Results: The prevalence of abscesses was 72.8% that was 311 cases among these 427 records of spinal tuberculosis collected during the study period. The total number of patients was dominated by men (53.6%) and the average age was 43.1 years. Computed tomography scan was the main diagnostic imaging (97.7%). The topography of soft tissue abscesses was: subcutaneous area (1.2%), paraspinal muscles (95.1%), retro-pharyngeal area (10.6%) and epidural area (19.6%). Osteoarticular lesions associated with abscesses were: Spondylodiscitis (96.1%), spondylitis (2.8%) and zygapophyseal arthritis and osteitis (4.5%). The majority of patients had tuberculosis treatment lasting 12 months: 2 months of the combination Rifampicin-Isoniazid-Pyrazinamide-Ethambutol following by 10 months of Rifampicin-isoniazid. The outcome was favorable marked by the resorption of abscesses and the healing of patients. Conclusion: The soft tissue abscesses are common in spinal tuberculosis in Abidjan. They mostly sit at the paraspinal muscles. Their treatment involves corticosteroid-associated with tuberculosis treatment.

Tuberculosis extrapulmonar en el niño / Extrapulmonary tuberculosis in children

Pulmonary tuberculosis (TB) is the most common type of TB in children. Extrapulmonary tuberculosis is also prevalent (about 30-40 percent of cases) and it can occur in a variety of anatomical sites. This study presents a review of the literature on the main clinical manifestations of extrapulmonary tuberculosis in children, its diagnosis and treatment. At the end, some reflections on the importance of BCG for prevention are presented.

La tuberculosis (TB) pulmonar es el tipo más común de TB en niños. La tuberculosis extrapulmonar también es frecuente (alrededor de 30-40 por ciento de los casos) y se puede presentar en una gran variedad de sitios anatómicos. Se hace una revisión de la literatura sobre las principales manifestaciones clínicas extrapulmonares de la tuberculosis en niños, su diagnóstico y su tratamiento. Al final se hacen algunas reflexiones sobre la importancia de la BCG para su prevención.

The application of Xpert MTB/RIF assay for rapid diagnosis of osteoarticular tuberculosis / 中国脊柱脊髓杂志

Objectives: To investigate the role of Xpert MTB/RIF assay for rapid diagnosis of osteoarticular tuberculosis.Methods: From February 2014 to November 2014,pus specimens of 49 osteoarticular tuberculosis patients and 32 nontuberculosis patients were detected by Xpert MTB/RIF system,and the sensitivity,specificity,positive predictive value,negative predictive value,agreement rate of Xpert MTB/RIF system were calculated,and clinical diagnosis was used as the reference standard.All the pus specimens were detected by acid-fast stain and fast culturing(BACTECT MGIT 960),to find the difference of sensitivity and specificity among Xpert MTB/RIF,acid-fast stain,and fast culturing.The role of Xpert MTB/RIF assay for rapid diagnosis of osteoarticular tuberculosis was evaluated through the two factors above.Results: It took 2.3±0.2h to detect each pus specimen by Xpert MTB/RIF.Among the 49 osteoarticular disease patients,46 were positive,3 were negative by Xpert MTB/RIF test.Among the 32 nontuberculosis patients,1 was positive,31 were negative by Xpert MTB/RIF test.The sensitivity,specificity,positive predictive value,negative predictive value,agreement rate was 93.87%,96.87%,97.87%,91.17%,95.06% respectively for Xpert MTB/RIF assay.Among the 46 specimens which were positive by Xpert MTB/RIF test,10 had rifampicin resistance mutation,with the rate of rifampicin resistance mutation as 21.73%.Among the 49 osteoarticular disease patients,8 were positive,41 were negative by acid-fast stain test,the sensitivity was 17.39%,and based on fast culturing test,11 were positive,38 were negative,the sensitivity was 23.91%.All pus specimens of 32 nontuberculosis patients were negative by acid-fast stain test and fast culturing test.As for the sensitivity,Xpert MTB/RIF was superior to acid-fast stain and fast cultureing (P＜0.05).While as for the specificity,there was no statistical difference among Xpert MTB/RIF,acid-fast stain,or fast culturing (P＞0.05).Conclusions: The role of Xpert MTB/RIF assay for rapid diagnosis of osteoarticular tuberculosis is perfect.It is of time saving,high sensitivity and high specificity,which is superior to the traditional methods.

Infección por Mycobacterium tuberculosis en una prótesis de cadera, reporte de un caso y revisión de la literatura / Mycobacterium tuberculosis infection in a hip prosthesis, a case report and literature review

Infection is the most serious complication of arthroplasty. It's a rare event usually caused by Staphylococcus spp. Prosthetic tuberculosis is rarely reported. We report the case of a 41 year-old patient who underwent a hip replacement for osteoarthritis and after multiple procedures an infection caused by Mycobacterium tuberculosis was documented. We review the literature of previously reported cases.

La infección es la complicación más seria de una artroplastia. Es un evento poco frecuente, usualmente causado por especies de Staphylococcus. La tuberculosis protésica es una entidad poco habitual. Comunicamos el caso de una paciente de 41 años sometida a un reemplazo de cadera por una artrosis y después de múltiples procedimientos se documentó una infección por Mycobacterium tuberculosis. Realizamos una revisión de la literatura de los casos previamente reportados.

Osteoarticular tuberculosis in an HIV-positive patient: a case report

The authors report a case of a 38-year-old HIV-positive woman, with subcutaneous nodules on the thoracic region with 3 months of evolution. Clinical, laboratory, and epidemiological features were evaluated and associated with apparent damage to the T11-T12 vertebrae, identification by imaging tests, positivity in a polymerase chain reaction-based test, and reactivity to the Mantoux tuberculin skin test (PPD-RT 23). The patient was diagnosed with osteoarticular tuberculosis and received treatment for a year, and clinical cure was achieved.

Clinical, radiological and molecular diagnosis correlation in serum samples from patients with osteoarticular tuberculosis

<p><b>OBJECTIVE</b>To assess the role of polymerase chain reaction (PCR) in serum samples, in the diagnosis of osteoarticular tuberculosis (OTB) in a setting where only clinical and imaging diagnoses determine the treatment.</p><p><b>METHODS</b>A total of 44 consecutive serum specimens were collected from clinically suspected OTB patients, based on clinical and radiological [X-ray or magnetic resonance imaging/computed tomography] features. They were screened by in-house nested PCR. In addition, a few specimens were examined by Gram stain, acid-fast bacilli stain, histopathology and routine bacterial culture. A total of 39 specimens were collected from patients suffering from other bone diseases of nontuberculous origin and included as negative controls.</p><p><b>RESULTS</b>Of the 44 clinically suspected OTB patients, in-house nested PCR was positive in 40 (91%) cases; PCR was negative in 38 (97%) negative controls. Sensitivity and specificity of our in-house nested PCR was 90.9% and 97.4%, respectively. The PCR report was available within 48 h. It was possible to standardize serum PCR technique and in positive cases, a good correlation was observed in terms of an adequate treatment response.</p><p><b>CONCLUSIONS</b>Nested PCR in serum samples is a rapid, highly sensitive and specific modality for OTB detection. PCR should be performed in addition to clinical evaluation, imaging studies, acid-fast bacilli staining, culture and histopathology diagnosis, if possible.</p>

Clinical, radiological and molecular diagnosis correlation in serum samples from patients with osteoarticular tuberculosis

Objective: To assess the role of polymerase chain reaction (PCR) in serum samples, in the diagnosis of osteoarticular tuberculosis (OTB) in a setting where only clinical and imaging diagnoses determine the treatment.Methods:A total of 44 consecutive serum specimens were collected from clinically suspected OTB patients, based on clinical and radiological [X-ray or magnetic resonance imaging/computed tomography] features. They were screened by in-house nested PCR. In addition, a few specimens were examined by Gram stain, acid-fast bacilli stain, histopathology and routine bacterial culture. A total of 39 specimens were collected from patients suffering from other bone diseases of nontuberculous origin and included as negative controls.Results:Of the 44 clinically suspected OTB patients, in-house nested PCR was positive in 40 (91%) cases; PCR was negative in 38 (97%) negative controls. Sensitivity and specificity of our in-house nested PCR was 90.9% and 97.4%, respectively. The PCR report was available within 48 h. It was possible to standardize serum PCR technique and in positive cases, a good correlation was observed in terms of an adequate treatment response.Conclusions:Nested PCR in serum samples is a rapid, highly sensitive and specific modality for OTB detection. PCR should be performed in addition to clinical evaluation, imaging studies, acid-fast bacilli staining, culture and histopathology diagnosis, if possible.

Clinical, radiological and molecular diagnosis correlation in serum samples from patients with osteoarticular tuberculosis

Objective: To assess the role of polymerase chain reaction (PCR) in serum samples, in the diagnosis of osteoarticular tuberculosis (OTB) in a setting where only clinical and imaging diagnoses determine the treatment. Methods: A total of 44 consecutive serum specimens were collected from clinically suspected OTB patients, based on clinical and radiological [X-ray or magnetic resonance imaging/computed tomography] features. They were screened by in-house nested PCR. In addition, a few specimens were examined by Gram stain, acid-fast bacilli stain, histopathology and routine bacterial culture. A total of 39 specimens were collected from patients suffering from other bone diseases of nontuberculous origin and included as negative controls. Results: Of the 44 clinically suspected OTB patients, in-house nested PCR was positive in 40 (91%) cases; PCR was negative in 38 (97%) negative controls. Sensitivity and specificity of our in-house nested PCR was 90.9% and 97.4%, respectively. The PCR report was available within 48 h. It was possible to standardize serum PCR technique and in positive cases, a good correlation was observed in terms of an adequate treatment response. Conclusions: Nested PCR in serum samples is a rapid, highly sensitive and specific modality for OTB detection. PCR should be performed in addition to clinical evaluation, imaging studies, acid-fast bacilli staining, culture and histopathology diagnosis, if possible.

Multifocal Skeletal Tuberculosis Involving the Lumbar Spine and Iliac Bone, Mimicking a Malignant Bone Tumour: A Case Report

Multifocal osteoarticular tuberculosis is uncommon and accounts for approximately10% of all cases of osteoarticular tuberculosis. Concomitant vertebral and iliac bone tuberculosis has not been reported in the literature to date. We report one such case for its unusual clinical and radiological presentation, which had presentation more similar to a malignant bone tumour than an infection.

Associação de osteomielite tibial e pneumonite por tuberculose miliar em paciente com lúpus eritematoso sistêmico / Association of tibial osteomyelitis and pneumonitis due to miliary tuberculosis in a patient with systemic lupus erythematosus

O lúpus eritematoso sistêmico (LES) é uma doença autoimune multissistêmica na qual há grande prevalência e manifestações incomuns de doenças infecciosas oportunistas, principalmente pelas múltiplas anormalidades no sistema imunológico e pelo efeito imunossupressor das medicações utilizadas em seu tratamento. Pacientes com LES têm incidência aumentada de tuberculose, e o acometimento osteoarticular ocorre em 1%-3% desses casos. Manifesta-se com dor, diminuição da mobilidade e aumento do volume osteoarticular, e os achados radiográficos costumam ser inespecíficos. A ressonância magnética nuclear (RMN) é exame útil para definir o grau de acometimento ósseo; entretanto, o diagnóstico etiológico é dado apenas pela cultura de líquido sinovial, pela cultura óssea ou pela histologia dessas regiões. Devido à inespecificidade dos achados, geralmente há atraso diagnóstico, em média de 11 meses. Relata-se o caso de uma paciente do gênero feminino com LES apresentando fatores predisponentes para a infecção/reativação da tuberculose. A RMN foi importante para definir o acometimento ósseo, e o diagnóstico etiológico foi dado pela biópsia óssea. A paciente também apresentava acometimento pulmonar devido à tuberculose, em sua forma miliar, demonstrado pela radiografia simples de tórax e pela tomografia computadorizada e confirmado pela cultura do bacilo de Koch no escarro. Houve demora de 1,5 mês para o início da terapêutica, tempo considerado curto em relação à literatura. Conclui-se dessa maneira que a tuberculose óssea, apesar de rara, deve sempre ser lembrada como diagnóstico diferencial nos pacientes lúpicos com osteomielite, principalmente naqueles com antecedente de tuberculose pulmonar.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, which has great prevalence and uncommon manifestations of opportunistic infectious diseases, mainly due to the multiple abnormalities of the immune system and the immunosuppressive effect of the medications used in its treatment. Patients whit SLE have an increased incidence of tuberculosis, and osteoarticular involvement occurs in 1%-3% of the cases, manifesting as pain, reduction in mobility, and increased osteoarticular volume. The radiographic findings are often nonspecific. Magnetic resonance imaging (MRI) is an useful test to define the severity of bone involvement; however, the etiological diagnosis can only be established by use of synovial fluid or bone cultures or the histological study of the affected areas. Due to the lack of specificity of the findings, there is usually a mean diagnosis delay of 11 months. We report the case of a female patient with SLE and predisposing factors for tuberculosis infection/reactivation. The MRI was important to define bone involvement, and the etiological diagnosis was established by use of bone biopsy. The patient also had lung involvement due to miliary tuberculosis, shown on plain chest radiography and CT scan and confirmed on culture of Mycobacterium tuberculosis in the sputum. There was a 1.5-month delay in beginning therapy, which is considered a short time when compared to the reports in the literature. In conclusion, bone tuberculosis, although rare, should always be remembered as a differential diagnosis of patients with SLE and osteomyelitis, mainly those with history of pulmonary tuberculosis.

Tuberculose articular multifocal acometendo pequenas articulações / Multifocal articular tuberculosis involving little joints

A tuberculose (TB) osteoarticular representa cerca 1% a 3% do total de casos de TB. Em 90% dos casos se apresentam sob a forma de monoartrite, sendo o acometimento de mais de uma articulação forma rara.As articulações com maior sobrecarga de peso são as mais frequentemente afetadas, em que o envolvimento do joelho e quadril responde por aproximadamente 50% dos casos. Punho e tornozelo são articulações raramente acometidas.Apresentamos o caso de um paciente com tuberculose multifocal, com comprometimento da articulação do punho e do pé, o que o torna bastante singular.

The spectrum of osteoarticular tuberculosis in Brunei Darussalam

Introduction: Tuberculosis (TB) is a public health problem worldwide including Brunei Darussalam. Osteoarticular involvement is common. The purpose of this study was to review the demographics, clinical features and treatment outcome of patients with osteoarticular tuberculosis (OATB) in Brunei Darussalam. Material and Methods: Patients receiving treatment for OATB between 2003 and 2008 were identified from the National Tuberculosis Coordinating Centre (NTCC) registry. Data was recorded on pre-designed proforma. Results: Twenty-one patients (10 male: 11 female) were identified with a mean age of 49 years (range 19 to 75). Nineteen were Bruneian citizens. The most common presenting symptoms were pain at affected site (n = 15), focal neurological deficit and loss of appetite (n = 7). Two patients gave a positive family history of TB and three had radiological evidence of pulmonary TB. Radiograph of the involved part was positive in nine cases while advanced imaging studies (computed tomography scan and magnetic resonance imaging) were required in 15 instances. The results of positive confirmatory tests were obtained from: smear (n = 10), culture (n = 3) and biopsy (n = 8). In five cases treatment had to be started without any of the confirmatory tests. The spine was the most common site of involvement (n = 12) with five non-spinal and four cases with combined lesions. Surgical intervention was required in six cases. All patients completed the treatment successfully. Conclusions: OATB is not uncommon in Brunei Darussalam and can present diagnostic problems. A high index of suspicion, early confirmation of diagnosis and complete monitored treatment is necessary for successful management of these cases.

A Case of Systemic Sclerosis Complicated with Multifocal Osteoarticular Tuberculosis / 대한류마티스학회지

Multifocal skeletal tuberculosis is defined as osteoarticular lesions that occur simultaneously at two or more locations. Cystic lesions of multiple bones in tuberculosis are encountered less frequently in adults than in children. The multifocal cystic skeletal tuberculosis involving hands and feet is rare, particularly. We report a case of systemic sclerosis that was treated with glucocorticoid and antirheumatic drug for many years and complicated with multifocal cystic skeletal tuberculosis. This case was misled to the diagnosis of staphylococcal pyogenic abscess by the first microbial culture of the draining pus. The sonographic finding suggested rather metastatic bone lesion or systemic inflammatory arthritis such as rheumatoid arthritis. Although it is rare, tuberculosis should be included in the differential diagnosis of multiple cystic systemic skeletal lesions in immunocompromised patients.

Tuberculosis Osteoarticular Primaria: Reaparición de una Patología Olvidada / Primary osteoarticular tuberculosis: the reappearance of a forgotten pathology

Presentamos dos casos de infección tuberculosa osteoarticular primaria, uno en el astrágalo y el otro en la columna vertebral, en pacientes aparentemente sanos y sin antecedentes epidemiológicos. Son casos representativos de la tuberculosis osteoarticular primaria, mostrando un aumento gradual en la última década en nuestro país, en pacientes sin alteraciones inmunológicas y sin antecedentes familiares o de contacto.

2 cases of osteoarticular tuberculosis infection are presented (one in the talus and the other in the spine) in seemingly healthy patients having no epidemic antecedents. These are representative cases of primary osteoarticular tuberculosis, showing a gradual increase over the last decade in Colombia in patients without immunological alterations and having no family antecedents or history of contact.