Vasculite por tuberculose ocular associada a eritema nodoso e à doença de Poncet / Ocular tuberculosis vasculitis associated with erythema nodosum and Poncet's disease

RESUMO A tuberculose intraocular deve ser sempre aventada como diagnóstico diferencial devido à sua alta significância nos agravos, além da alta morbidade da infecção sistêmica. Essa condição pode se apresentar associada a manifestações extraoculares pouco prevalentes da tuberculose. O autor relatou um caso de vasculite por tuberculose ocular, associada a eritema nodoso e à doença de Poncet, com resolução dos achados e sintomas após esquema padrão para tuberculose.

ABSTRACT Intraocular tuberculosis should always be deemed as a differential diagnosis due to its high importance, in addition to the high morbidity of systemic infection. This condition may be associated with extraocular manifestations that are not prevalent in tuberculosis. The author reported a case of ocular tuberculosis vasculitis associated with erythema nodosum and Poncet's disease, with resolution of the medical findings and symptoms after the standard treatment for tuberculosis.

Polyarthritis, hyperuricemia and right shoulder pain: a report of one case with literature review / 中华风湿病学杂志

Objective:To improve the clinical differential diagnosis ability of rheumatoid arthritis (RA) complicated with gout and septic arthritis (SA).Methods:The clinical characteristics, diagnosis, and treatment of one RA patient with hyperuricemia and recurrent swelling and pain in right shoulder were reported and discussed.Results:A patient, with a history of RA for 10 years, hyperuricemia for 8 years, recurrent swelling and pain in right shoulder for 1 year. RA, gout, and SA were diagnosed before, and the response was poor after symptomatic treatment. In recent 1 month, the symptom was aggravated with the formation of fistula on the right shoulder. The laboratory tests for tuberculosis T cell interferon release test (IGRA) and tuberculin (PPD) test were negative, and the CD4 + cell count decreased. The comprehensive analysis of the imaging with right shoulder showed MSU deposition on right shoulder, with bone erosion, bone destruction, bone marrow edema, joint effusion, and multiple sites of connective tissue involvement (synovial bursa, tendon sheath, tendon, and muscle) GeneXpert MTB/RIF (GeneXpert), metagenomic next-generation sequencing (mNGS) of puncture fluid and joint fluid culture prompted Mycobacterium tuberculosis complex group. He was finally diagnosed with RA, gout, and osteoarticular tuberculosis (OAT). Symptoms were relieved after symptomatic treatment. Conclusion:RA patients with hyperuricemia have recurrent single arthritis. In addition to considering for gout, the presence of OAT should also be considered. The immune functional status of the patient and drug used may interfere with the interpretation of immune function tests. It is necessary to integrate the clinical characteristics of patients, a variety of imaging examinations, and etiological detection to confirm the diagnosis and avoid misdiagnosis.

Hallazgos de tuberculosis extrapulmonar en imágenes de resonancia magnética en una paciente pediátrica / MRI findings on extrapulmonary tuberculosis in a pediatric patient

Resumen | La tuberculosis pulmonar es la más común en niños y su forma extrapulmonar corresponde aproximadamente a 30 a 40 % de los casos. Se presenta el caso de una niña indígena con tuberculosis diseminada: pulmonar, cerebral, medular y musculoesquelética, con importantes secuelas en el neurodesarrollo. Este caso ilustra el espectro de la tuberculosis extrapulmonar pediátrica en países endémicos en desarrollo. Además, evidencia la gravedad de las complicaciones neurológicas causantes de grave discapacidad y resalta el valor de las imágenes radiológicas para orientar la sospecha diagnóstica de compromiso extrapulmonar.

Abstract | Pulmonary tuberculosis is the most common in children and its extrapulmonary manifestations are present in 30% to 40% of cases. We present the case of an indigenous girl with disseminated tuberculosis: pulmonary, brain, medullary, and musculoskeletal with substantial neurodevelopmental sequelae. This case exemplifies the spectrum of pediatric extrapulmonary tuberculosis in endemic developing countries. Furthermore, it shows the severity of highly disabling neurological complications and stresses the importance of radiological imaging in guiding diagnostic suspicion of extrapulmonary involvement.

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)

Notification of 6442 cases of bone tuberculosis in Brazil: epidemiological profile from 2009 to 2018 / Notificação de 6442 casos de tuberculose óssea no Brasil: perfil epidemiológico de 2009 a 2018 / Notificación de 6442 casos de tuberculosis ósea en Brasil: perfil epidemiológico de 2009 a 2018

ABSTRACT Objective: To analyze the occurrence of notified cases of bone tuberculosis in Brazil during the period from 2009 to 2018. Methods: Quantitative, descriptive and retrospective study. The data consisted of cases reported to the Notifiable Diseases Information System (SINAN) of DATASUS. To analyze the results, the non-parametric statistical Chi-squared and G tests, capable of expressing statistical associations, were used. Results: 6,442 cases of bone tuberculosis were reported in Brazil, with an average of 644.2 cases per year. The Southeast was responsible for 41.5% of the cases (n = 2676). The extrapulmonary form accounted for 87.9% (5661). There was a predominance in males (66.1%, n = 4258), Whites (41.6%, n = 2678) and in the above 35 years of age group (73.9%, n = 4757). In the data collected, the risk factor data was not correctly filled out, making reliable statistical associations impossible in this study, mainly between alcoholism, tobacco use, AIDS, diabetes, mental illness, illicit drug use and homelessness. Conclusion: There was greater notification of cases of bone tuberculosis in the Southeast and Northeast regions of Brazil, which predominantly affected young, economically productive men. Tuberculosis has a correlation with diabetes, HIV / AIDS, smoking and alcohol and drug use, according to the results of this study. Level of evidence II; Retrospective, analytical, quantitative and descriptive study.

RESUMO Objetivo: Analisar a ocorrência de casos de tuberculose óssea notificados no Brasil entre o período de 2009 a 2018. Métodos: Estudo quantitativo, descritivo e retrospectivo. Os dados consistiram em casos notificados no Sistema de Informação de Agravos de Notificação (SINAN) do DATASUS. Para análise dos resultados, foram usados testes estatísticos não paramétricos, Qui-quadrado e teste G, capazes de expressar associação estatística. Resultados: Foram notificados 6.442 casos de tuberculose óssea no Brasil, com média de 644,2 casos por ano. O Sudeste foi responsável por 41,5% dos casos (n = 2676). A forma extrapulmonar correspondeu a 87,9% (5.661). Houve predomínio no sexo masculino (66,1%, n = 4258), em brancos (41,6%, n = 2678) e maiores de 35 anos (73,9%, n = 4757). Os dados coletados não tinham preenchimento correto dos fatores de risco, o que impossibilitou a associação estatística confiável neste estudo, principalmente entre alcoolismo, tabagismo, AIDS, diabetes, doença mental, uso de drogas ilícitas e moradores de rua. Conclusões: Houve maior notificação de casos de tuberculose óssea no Sudeste e no Nordeste do Brasil, que afetou predominantemente homens jovens e em plena atividade econômica. A tuberculose tem correlação com diabetes, HIV/AIDS, tabagismo e uso de álcool e drogas ilícitas, conforme os resultados deste estudo. Nível de evidência II; Estudo retrospectivo, analítico, quantitativo e descritivo.

RESUMEN Objetivo: Analizar la ocurrencia de casos de tuberculosis ósea notificados en Brasil en el período de 2009 a 2018. Métodos: Estudio cuantitativo, descriptivo y retrospectivo. Los datos consistieron en casos notificados en el Sistema de Información de Enfermedades de Notificación (SINAN) del DATASUS. Para análisis de los resultados, fueron usados tests estadísticos no paramétricos, Chi-cuadrado y test G, capaces de expresar asociación estadística. Resultados: Fueron notificados 6.442 casos de tuberculosis ósea en Brasil, con promedio de 644,2 casos por año. El sudeste fue responsable por 41,5% de los casos (n = 2676). La forma extrapulmonar correspondió a 87,9% (5661). Hubo predominio en el sexo masculino (66,1%, n = 4258), en blancos (41,6%, n = 2678) y mayores de 35 años (73,9%, n = 4757). Los datos colectados no tenían llenado correcto de los factores de riesgo, lo que imposibilitó la asociación estadística confiable en este estudio, principalmente entre alcoholismo, tabaquismo, SIDA, diabetes, enfermedad mental, uso de drogas ilícitas y personas sin techo. Conclusiones: Hubo mayor notificación de casos de tuberculosis ósea en el sudeste y en el noreste de Brasil, que afectó predominantemente a hombres jóvenes y en plena actividad económica. La tuberculosis tiene correlación con diabetes, VIH/SIDA, tabaquismo y uso de alcohol y drogas ilícitas, conforme a los resultados de este estudio. Nivel de evidencia II; Estudio retrospectivo, analítico, cuantitativo y descriptivo.

Tuberculosis en húmero proximal. Un diagnóstico infrecuente en infecciones articulares / Tuberculosis in the proximal humerus. A rare diagnosis in joint infections

Resumen La incidencia de Tb osteoarticular es mucho menor que la pulmonar, representando 1-2% de los casos de Tuberculosis (Tb) y el 10% de los casos de Tb extrapulmonar, por lo que usualmente no es considerada para el diagnóstico diferencial de pacientes con enfermedad articular. Su diagnóstico es difícil y se basa en hallazgos clínicos, radiológicos, bacteriológicos e histológicos. Las lesiones extrapulmonares son paucibacilares y las muestras, en la mayoría de los casos, difíciles de obtener, por lo que el diagnóstico a menudo es simplemente presuntivo. La tuberculosis articular en etapas tempranas, presenta manifestaciones clínicas e imagenológicas inespecíficas. Esto puede facilitar la progresión de la enfermedad local, generando lesiones osteoarticulares graves y, finalmente, la destrucción articular. Se presenta el caso de una paciente de 60 años, intervenida quirúrgicamente por presentar manifestaciones clínicas e imagenológicas compatibles con una ruptura del manguito rotador, y cuya evolución tórpida posoperatoria, llevó al diagnóstico bacteriológico de tuberculosis de húmero proximal.

Abstract The incidence of osteoarticular TB is much lower than that of the lung, representing 1-2% of TB cases and 10% of extrapulmonary TB cases, so it is often not considered for the differential diagnosis of patients with joint disease. Its diagnosis is difficult and is based on clinical, radiological, bacteriological and histological findings. Extrapulmonary lesions are paucibacillary and specimens, in most cases, difficult to obtain, so the diagnosis is often simply presumptive. Joint tuberculosis in early stages presents nonspecific clinical and imaging manifestations. This can lead to the progression of the local disease, generating severe osteoarticular lesions and, finally, joint destruction. We present the case of a 60-year-old patient who underwent surgery due to clinical and imaging manifestations compatible with a rotator cuff tear, and whose torpid postoperative evolution led to the bacteriological diagnosis of proximal humerus tuberculosis.

Migración infrecuente de tuberculosis extrapulmonar primaria: reporte de caso / Infrequent migration of primary extrapulmonary tuberculosis: case report / Migração infreqüente de tuberculose extrapulmonar primária: relato de caso

Resumen: A nivel global, la tuberculosis de localización extrapulmonar representa el 18% de los casos de la enfermedad, teniendo como lugares más frecuentes de afectación la pleura (54%), ganglios (11,1%), sistema nervioso central (9%) y sistema osteoarticular (3,6%), entre otros. La manifestación clínica de la meningoencefalitis tuberculosa se presenta con fiebre, cefalea, vómitos, alteración de la conciencia, fotofobia, afectación de pares craneales, alteraciones audiovisuales, signos de irritación meníngea y focalización neurológica. La tuberculosis ostearticular es consecuencia de una diseminación hemática, linfática o, excepcionalmente, por inoculación directa. La clínica es insidiosa, con dolor, inflamación y disminución del rango articular, pudiendo presentar abscesos y cavidades supurativas. Sin embargo, existen otros síntomas de baja frecuencia de aparición, dificultando el diagnóstico adecuado. Se describe el caso clínico infrecuente de tuberculosis extrapulmonar, destacando la diseminación de Mycobacterium tuberculosis con foco en la articulación coxofemoral izquierda hacia meninges y cerebro, y el uso inapropiado del tratamiento con corticoesteroides en un paciente seronegativo para VIH.

Abstract: Extrapulmonary tuberculosis accounts for 18% of tuberculosis cases, with the pleura (54%), lymph nodes (11.1%), central nervous system (9%) and osteoarticular system (3.6%) as sites of involvement, among others. Clinical manifestations of tuberculous meningoencephalitis are fever, headache, vomiting, altered consciousness, photophobia, cranial nerve involvement, audiovisual alterations, signs of meningeal irritation and neurological focalization. Ostearticular tuberculosis is the result of hematic, lymphatic dissemination or, exceptionally, by direct inoculation. The clinic is insidious, with pain, inflammation and diminished joint range, and can present abscesses and suppurative cavities. However, there are other symptoms of low frequency of appearance, making the diagnosis difficult. For this reason, an infrequent clinical case of extrapulmonary tuberculosis is described, highlighting the spread of Mycobacterium tuberculosis with focus on the left coxofemoral joint to the meninges and brain, and the inappropriate use of adrenal cortex hormones therapy in a seronegative patient for HIV.

Resumo: A tuberculose extrapulmonar é responsável por 18% dos casos de tuberculose, com pleura (54%), linfonodos (11,1%), sistema nervoso central (9%) e sistema osteoarticular (3,6%) como locais de envolvimento. entre outros. A manifestação clínica da meningoencefalite tuberculosa é febre, dor de cabeça, vômitos, consciência alterada, fotofobia, comprometimento dos nervos cranianos, alteraçõesaudiovisuais, sinais de irritação meníngea e focalização neurológica. A tuberculose ostearticular é o resultado de disseminação hemática, hemática ou, excepcionalmente, por inoculaçãodireta. A clínica é insidiosa, comdor, inflamação e diminuição do leque de articulações, podendoapresentarabscessos e cavidades supurativas. No entanto, existemoutrossintomas de baixafrequência de aparecimento, dificultando o diagnóstico. Por esta razão, nósdescrevemosum caso clínico raro de tuberculoseextrapulmonar, com destaque para a disseminação de Mycobacterium tuberculosis com foco naarticulação do quadrilesquerdo para meninges e cérebro, e uso inadequado de corticoterapiaem paciente soronegativa HIV.

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

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.

Correlation between expression of immune molecules of erythrocyte and T lymphocyte subsets in bone and joint tuberculosis patients in Western Guangxi / 重庆医学

Objective To investigate the changes of CD35 and CD59 of erythrocyte and T lymphocyte subsets and their sig-nificances in patients with bone and joint tuberculosis and pulmonary tuberculosis .Methods Venous blood was extracted from 60 bone and joint tuberculosis patients ,60 pulmonary tuberculosis patients ,and 90 healthy individuals(control group) .Flow cytometry (FCM ) was used to detect the concentration of T lymphocyte subsets ,such as CD3 + ,CD4 + ,CD8 + and CD4 + /CD8 + ,as well as im-mune molecules of erythrocyte ,such as CD35 and CD59 .Results CD3 + ,CD4 + ,CD4 + /CD8 + ,CD35 and CD59 in bone and joint tu-berculosis group and pulmonary tuberculosis group were significantly lower than those in control group(P 0 .05) .Conclusion Compared with the ordinary people ,there are significant differences be-tween erythrocyte and T lymphocyte immune in patients with bone and joint tuberculosis and pulmonary tuberculosis ,but it is the reason or the results need to be further studied .

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.

Efficiency of one-stage posterior median incision via costotransverse joint in treating thoracic spinal tuberculosis / 中华全科医师杂志

Objective To assess the efficacy of one-stage posterior median incision via costotransverse joint in treating thoracic spinal tuberculosis.Methods Thirty three patients with tuberculosis of thoracic spine undergoing one-stage posterior thoracic spine debridement,bone grafting fusion and posterior instrumentation from July 2011 to October 2013 were included in the study.There were 18 males and 15 females.The age was from 17 to 39 years old with an average of 29.5.The course was from 5 to 11 months with an average of 7.3.The Cobb angle was from 19° to 42° with an average of 29.8°.There were 5 in upper thoracic spine,17 in middle thoracic spine and 11 in lower thoracic spine.6 were in Frankel scale grade C,11 were in grade D and 16 were in grade E before surgery.Postoperative kyphosis correction,recovery of neurological function and bone fusion were observed.Results All the surgeries were completed successfully.The operation time was from 120 to 230 min with an average of 183.The blood loss during operation was from 480 to 700 ml with an average of 530.All 33 patients were followed-up for 12-36 months with an average of 22.7 months.The Cobb angle was from 8° to 15° with an average of 10.2°,the correction rate was 77％.The Frankel scale of 11 patients recovered from D to E,2 recovered from C to D and 4 recovered from C to E.The postoperative kyphosis correction and Frankel scale were significantly improved,all patients had a 100％ bone fusion rate and there were no internal fixation loosened or shift of graft bone at the last follow-up.ESR and CRP were returned to the normal range and the tuberculosis symptoms disappeared.Conclusions One-stage posterior median incision via costotransverse joint can complete surgery by the same position and the same incision in treating thoracic spinal tuberculosis with safety and good clinical efficacy.

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.

Tuberculosis como causas de osteomielitis en edad pediátrica: a proposito de un caso de osteomielitis en astrágalo / Tuberculosis as a cause of osteomyelitis in childhood: report of a case of osteomylitis of the talus

La osteomielitis hematógena es frecuente en la metáfisis de los huesos largos en la infancia; siendo esta misma afectación rara en otras localizaciones y más aun, extremadamente rara en el astrágalo, tanto así que se reportan solo unos pocos casos y de manera esporádica en la literatura mundial. En este trabajo presentamos un caso clínico, de una paciente preescolar que presento osteomielitis hematógena de astrágalo cuyo tratamiento médico y quirúrgico representaron y aun representan todo un reto para el ejercicio clínico debido a la dificultad del diagnostico etiológico y tórpida evolución.

Hematogenous osteomyelitis is frequent in the metaphysis of long bones in childhood, being the same affection rare in other locations and even more, extremely rare in the talus, so much so that only a few reported sporadic cases and literature world. We present a clinical case of a patient presenting preschool hematogenous osteomyelitis of the talus which medical and surgical treatment represented and still represent a challenge for clinical practice because of the difficulty of diagnostic and torpid evolution.

Tuberculose vertebral: análise descritiva de uma série de casos submetidos a tratamento cirúrgico / Tuberculosis of the spine: descriptive analysis of a series of cases surgically treated / Tuberculosis vertebral: un análisis descriptivo de una serie de casos sometidos al tratamiento quirúrgico

OBJETIVO: apresentar a casuística cirúrgica no tratamento da tuberculose vertebral e comparar os resultados com a literatura atual. MÉTODOS: foi realizada a análise retrospectiva dos prontuários dos pacientes submetidos à cirurgia para tratamento da espondilite tuberculosa. Foram estudados o tipo de cirurgia realizada, o estado neurológico e o grau de cifose antes da cirurgia e ao final de 12 meses. O Estado neurológico foi definido pela escala de Frankel modificada. A deformidade cifótica foi medida pelo método de Cobb. Foram identificados 23 pacientes com diagnóstico confirmado de tuberculose vertebral. Foram submetidos a tratamento cirúrgico 13 dos 23 pacientes. Três pacientes foram excluídos e dez pacientes participaram do estudo. RESULTADOS: a maioria dos pacientes foi submetida à descompressão, artrodese anterior e posterior por via combinada ou posterior com instrumentação. Seis dos dez pacientes apresentavam déficit neurológico ao diagnóstico, sendo duas crianças que apresentavam a lesão denominada de Mal de Pott à admissão. Três pacientes apresentaram recuperação completa da função motora dos membros inferiores. Um paciente apresentou piora do déficit neurológico após a cirurgia devido à resistência bacteriana ao uso de quatro drogas diferentes e à meningite tuberculosa.(...) Não se observou progressão significativa da cifose em nenhum dos pacientes operados. CONCLUSÃO: o tratamento cirúrgico da espondilite tuberculosa nesta série de casos foi eficaz na prevenção da progressão da cifose avaliada em um período mínimo de 12 meses. O déficit neurológico relacionado à tuberculose vertebral foi mais grave nas crianças.

OBJECTIVE: to present our experience on the surgical treatment of spinal tuberculosis and to compare our data to the recent literature. METHODS: a retrospective evaluation of patients who underwent surgical procedure to treat the disease was done. We analyzed the type of surgery, neurological status and angle of kyphosis before the surgery and after twelve months. The neurological status was determined by the Frankel scale modified by ASIA. The kyphotic deformity was measured using the Cobb method. We identified 23 patients with confirmed diagnosis of tuberculosis of the spine. Thirteen individuals in this group were operated. Three patients were excluded and ten participated in the study. RESULTS: most of the patients underwent decompression, anterior and/or posterior fusion by combined or posterior approach. Six patients presented neurological deficit at the time of diagnosis. Two of these six were children and presented with Pott's disease on admission. Three patients presented complete recovery of the motor function of their legs. One patient had neurological status aggravated after the surgery due to bacterial resistance at the administration of four different drugs and to tuberculous meningitis. (...)We did not observe important kyphotic angle increase in any operated patient at the end of the study. CONCLUSION: The surgical treatment was efficient to prevent kyphosis progression. The neurological deficit associated with spinal tuberculosis was critical in children.

OBJETIVO: presentar la casuística quirúrgica en el tratamiento de la tuberculosis vertebral y comparar los resultados con la literatura actual. MÉTODOS: se realizó un análisis retrospectivo de las historias clínicas de los pacientes sometidos a la cirugía para el tratamiento de la espondilitis tuberculosa. Fueron estudiados el tipo de cirugía realizada, el estado neurológico y el grado de la cifosis antes de la cirugía y al final de 12 meses. El estado neurológico fue definido por la escala de Frankel modificada. La deformidad cifótica fue medida por el método de Cobb. Fueron identificados 23 pacientes con diagnóstico confirmado de tuberculosis vertebral. Fueron sometidos a tratamiento quirúrgico 13 de los 23 pacientes. Tres pacientes fueron excluidos y diez pacientes participaron del estudio. RESULTADOS: la mayoría de los pacientes fueron sometidos a la descompresión, artrodesis anterior y posterior por vía combinada o posterior con instrumentación. Seis de los diez pacientes presentaban un déficit neurológico al momento del diagnóstico, siendo que dos niños presentaban la lesión denominada de Mal de Pott en el momento de la admisión. Tres pacientes presentaron recuperación completa de la función motora de los miembros inferiores. Un paciente empeoró su déficit neurológico después de la cirugía debido a la resistencia bacteriana por el uso de cuatro fármacos diferentes y a la meningitis tuberculosa. (...) No fue observada progresión significativa de la cifosis en ninguno de los pacientes operados. CONCLUSIÓN: el tratamiento quirúrgico de la espondilitis tuberculosa en esta serie de casos fue eficaz en la prevención de la progresión de la cifosis evaluada en un periodo mínimo de 12 meses. El déficit neurológico relacionado a la tuberculosis vertebral fue más grave en los niños.

Tuberculose refratária disseminada com acometimento do tendão bicipital em paciente imunocompetente / Disseminated refractary tuberculosis with biceps tendon involvement in an immunocompetent patient

OBJETIVO: Relatar um caso raro de tuberculose disseminada em paciente imunocompetente, que evoluiu, durante o tratamento medicamentoso padrão, com envolvimento do tendão da porção longa do bíceps e da articulação do ombro. MÉTODOS: À primeira avaliação, o diagnóstico correto não foi feito e o paciente foi tratado com fisioterapia para tendinopatia do manguito rotador. Entretanto, apresentou rápida formação de massa na região anterior do terço proximal do braço e piora da dor. A punção da massa revelou líquido amarelado, cuja análise laboratorial confirmou tratar-se de infecção por M. tuberculosis. RESULTADOS: O paciente foi tratado com desbridamento cirúrgico e troca do esquema medicamentoso e evoluiu com resolução do quadro infeccioso e melhora completa da função do ombro direito. CONCLUSÃO: Devido a sua alta prevalência no Brasil, a tuberculose deve sempre ser considerada no diagnóstico diferencial dos casos de comprometimento crônico e progressivo das articulações, ossos, músculos, tendões e bursas, mesmo em indivíduos imunocompetentes.

OBJECTIVE: The authors report a rare case of disseminated tuberculosis which had compromised the long head of biceps tendon and shoulder joint, during standard drug therapy. METHODS: On a first sight, the accurate diagnosis wasn't accomplished and the patient had been treated with physiotherapy for rotator cuff tear. However, the patient presented with a fast growing mass in anterior region of the proximal third of the arm, complaining of pain increase. Aspirative punction of the mass revealed a yellow fluid and the laboratorial analysis confirmed infection by M. Tuberculosis. The patient was treated with surgical debridement and his drug therapy was changed. RESULTS: Resolution of infectious status and complete shoulder function restoration was succeeded. CONCLUSION: Due to its high prevalence in Brazil, tuberculosis must always be considered as a possible cause of inflammatory joint disease, even in immunocompetent patients.

A Case of Tuberculous Arthritis Following the Use of Etanercept

Etanercept is a tumor necrosis factor (TNF) inhibitor that has been used for the treatment of chronic inflammatory diseases including rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Because of its immunosuppressive activity, opportunistic infections have been noted in treated patients, most notably caused by Mycobacterium tuberculosis. Tuberculosis may present in an extrapulmonary or disseminated form. Since TNF-alpha inhibitors have been used in Korea, a few cases of TNF-alpha inhibitor associated tuberculosis have been described. However, tuberculous arthritis has not been previously reported. We describe a case of tuberculous arthritis in a 57-year-old woman with rheumatoid arthritis who was treated with etanercept.

The MRI Findings of Skull Tuberculosis: A Case Report

The incidence of skull tuberculosis is very rare, with only a few cases reported as a result of a simple radiography and computed tomographic findings. In this study, we report the magnetic resonance image (MRI) findings of a case of skull tuberculosis, which was confirmed histologically.

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.

X-ray,CT and MRI findings of synovial tuberculosis in joints / 中华放射学杂志

Objective To analyze the X-ray,CT and MRI findings of synovial tuberculosis,and to evaluate the role of MRI in diagnosing synovial tuberculosis.Methods Fourteen eases of synovial tuberculosis comfirmed by operation and pathology were retrospectively analyzed and summarized. All patients were examined by MRI and X-ray,and CT scans were performed in 3 cases. Results X-ray showed joint swelling(8 cases),articular space narrowing(7 cases),marginal joint erosions(4 cases), and periarticular osteoporosis(9 cases).The joint swelling was detected on CT in all 3 cases,and bony erosion and speckled sequestra were seen in 2 cases.MRI in all of patients showed joint swelling and synovial proliferation in different drgees,demonstrated as heterogeneously low signal on T_1 WI and slight high signal(7 cases)and obvious high signal(6 cases)on T_2WI,and diffuse synovial proliferation was demonstrated as massive and nodular signal in 8 cases.Joint effusion was present in 7 cases as low signal on T_1WI and high signal on T_2 WI.Osseous erosion lesions were seen in 7 cases,and intra-artieular cartilage thinned,partly or mostly disappeared in 11 cases.Periarticular bone marrow edema was found in 7 cases. Conclusion MRI was superior to X-ray and CT in the diagnosis and differential diagnosis of synovial tuberculosis.