Calcaneal Osteomyelitis Presenting as a Paradoxical Reaction during Treatment of Multidrug-Resistant Tuberculosis

Tuberculosis in the foot progresses gradually; thus, diagnosis is usually delayed, and early treatment is rarely provided. If osteomyelitis occurs due to delayed diagnosis and treatment, surgical treatment should be considered. We report the case of a 46-year-old man with osteomyelitis of the calcaneus who was diagnosed with multidrug-resistant pulmonary tuberculosis and he was treated with anti-tuberculosis drugs. Bilateral adrenal masses, abscess of both testes and a small wound in the left plantar heel were observed. Both adrenal masses and abscess were regarded as paradoxical reaction of anti-tuberculosis treatment. After 1 month, he developed a pain in the left plantar heel that was compatible with calcaneal osteomyelitis in radiological features. He underwent right orchiectomy for right scrotal abscess aggravation and surgical treatment for left calcaneal osteomyelitis. Mycobacterium tuberculosis was confirmed by polymerase chain reaction. The patient was immobilized by cast for 8 weeks and the heel pain gradually improved.

Histopathological study of bone lesions – review of 102 cases.

Background: A spectrum of pathological bone lesions can be presented in any form from inflammatory to neoplastic conditions. Diagnosis of all bone lesions is made by radiological modalities like plain X-ray, CT scan, MRI and bone scintigraphy. Aim and Objectives: To study histopathological features of bone lesions and correlate them with age, site and type of lesions. Material and Methods: The study was carried out at tertiary care center from April 2013 to November 2013. A total of 102 bone lesions were analyzed. Bone biopsy was performed after detailed clinical and radiological examination. After fixation, decalcification, processing and H&E staining, histopathological diagnosis was made. Results: Out of all 102 cases, 44.11% bone lesions were found between 25-50 years with male predominance. The incidence of non neoplastic lesions was 74.5% and neoplastic lesions were 25.4%. Amongst neoplastic lesions, incidence of benign tumors was 17.64% and malignant tumors were 7.8%. The Tuberculous Osteomyelitis was most common non neoplstic lesion while giant cell tumor and osteochondroma were common among benign tumors and osteosarcoma and Secondary metastasis were common among malignant bone tumors. Conclusion: Though Bone tumors are less common, if viewed in perspective of clinico radiology and histopathology, correct diagnosis can be made.

Un caso de osteomielitis tuberculosa de clivus / A rare case of tuberculous clivus osteomyelitis

Se presenta un caso de infección tuberculosa con osteomielitis de clivus con afectación de tejidos vecinos y debut como cefalea refractaria sin clínica pulmonar. La osteomielitis tuberculosa de clivus es una entidad descrita en la literatura de forma excepcional y más propia de áreas con alta prevalencia de tuberculosis. Este caso debutó con clínica neurológica poco específica y se llegó al diagnóstico por el resultado del estudio microbiológico de nódulos pulmonares coexistentes sin clínica pulmonar asociada.

We report a case of tuberculous infection of exceptional location: clivus with involvement of surrounding tissues and refractory headache without pulmonary clinic. Tuberculous osteomyelitis of the clivus is a rare entity described in areas with highest tuberculosis prevalence. This case debuts with unspecific neurological symptoms and was diagnosed by the results of microbiological study of coexisting pulmonary nodules, without associated pulmonary clinic.

Tuberculous Osteomyelitis of the bone flap following Craniotomy.

A patient of tuberculous osteomyelitis of the bone flap following craniotomy for acute subdural hemorrhage which was treated at Surat Municipal Institute of Medical Education & Research (SMIMER) from June 2010 has been reported. This report emphasizes the fact that while treating osteomyelitis of bone flap following craniotomy, possibility of tuberculosis should be considered, especially in our country. Treatment wise, the disease responded readily to routine anti-tubercular chemotherapy.

Cystic bone tuberculosis in children - A case series.

Cystic tuberculosis of the bone is a rare form of tuberculosis (TB) osteomyelitis associated with disseminated lesions. In children, the lesions involve the peripheral skeleton, are symmetric and less sclerotic while in adults, the lesions are axial and predominantly sclerotic. TB dactylitis and spina ventosa are the other common variants of TB osteomyelitis seen in children below five years. Here we report seven cases of cystic TB bone disease. There were three males and four females with age of diagnosis between 2-11 years. Most patients presented with localized swelling and pain. X-rays revealed classical cystic lesions and spina ventosa. Four children had multiple cystic lesions and three had isolated lesions. Diagnosis was confirmed by FNAC of the bone or histopathological / radiological evidence of TB. The patients responded well to anti-tubercular therapy. The entity of cystic TB bone disease should be borne in mind as, lack of awareness may delay diagnosis and treatment. Biopsy is mandatory to confirm diagnosis and antitubercular drugs are the mainstay of therapy. Curettage of affected bone in selected cases may promote early healing. Response to therapy is excellent and the overall prognosis is good.

Tuberculous Osteomyelitis of the Tarsal Bone in an Infant: Case Report / 대한정형외과학회잡지

Osteoarticular tuberculosis is a rare condition and it makes up 1-3% of all cases of tuberculosis. It usually occurs at the vertebra and it is common knowledge that tuberculous osteomyelitis is very rare at the foot. The clinical symptoms are nonspecific, and it can also mimic a wide range of pathologies, so it takes a lot of time to diagnosis and treat this illness. When osteoarticular tuberculosis is diagnosed, it should be gone through side to side with thorough debridement and chemotherapy. The author has experience 2 case of tuberculous osteomyelitis, so I report here on the diagnosis and treatment of this illness.

Two Cases of Scrofuloderma / 대한피부과학회지

Scrofuloderma results from a direct extension of an underlying tuberculosis focus such as the lymph node, bone or joint to the underlying skin, and is often associated with pulmonary tuberculosis. One 72-year-old man presented with erythematous swollen patch with scales on the left hand and erythematous swollen patch on the left elbow. He had tuberculous osteomyelitis of left elbow. And another patient who is a 59-year-old man presented with hemorrhagic, purulent ulcers with crust and exudate on the left and right chest. Each size of ulcers are 6.0x5.0cm and 5.0x5.0cm. He had reactive pulmonary tuberculosis and tuberculous spondylitis. Biopsy specimens from the skin showed lymphocytes, epitheloid cells, and Langerhan's giant cells with caseation necrosis. Acid-fast bacilli were identified on AFB staining. We report two unusual cases of scrofuloderma associated with tuberculous osteomyelitis and pulmonary tuberculosis respectively.