Tuberculosis osteoarticular y osificaciones heterotópicas: reporte de un caso / Heterotopic ossification and osteoarticular tuberculosis: case report

La osificación heterotópica es una condición patológica que conduce al desarrollo de hueso en el tejido blando. En la piel se denomina osteoma cutis. Estas lesiones se clasifican en primarias o secundarias. Las causas secundarias constituyen el 85% y son consecuencia de enfermedades inflamatorias, infecciones, tumores, traumatismos, lesiones de médula espinal y cirugías. Si bien la osificación heterotópica es benigna e infrecuente, puede ser una enfermedad debilitante que, asociada a dolor y rigidez, provoque mayor comorbilidad en relación con la enfermedad que la desencadenó. Comunicamos el caso de un paciente que padeció osteoma cutis asociado a tuberculosis osteoarticular

Heterotopic ossification is a patologic condition that leads bone formation in soft tissue. In particular, osteoma curtis, which can be primary or secundary, occurs when ossification if found in the skin. Secondary lessions account 85% of the cases described and they are by inflammatory diseases, infections, tumors, traumas, spinal cord lesions and surgeries. Whereas heterotopic ossification is benign and rare, it may result in wasting sickness that in combination with pain and stiffness, adding comorbidity to the disease that triggers. We report here a patient suffering osteomas cutis and osteoarticular tuberculosis. (AU)

Tuberculous Synovitis of Knee Joint.

Tuberculosis of the appendicular skeleton is an uncommon infection by tubercle bacilli. Thirty percent of the skeletal tuberculosis involves joints, the knee being the third most common joint affected. We report a case of tuberculous synovitis of the knee joint in a 69 years old male. The diagnosis was done by Ziehl – Neelsen stain and culture on Lowenstein – Jensen medium of the synovial fluid along with X-ray finding of the knee joint. Though the sputum sample was negative for AFB, X-ray of the chest showed finding suggestive of old pulmonary tuberculosis. The patient was treated with the anti tubercular regimen and responded well .

experience with a rare diagnosis of isolated tuberculosis of sternum at JNMC hospital, Aligarh, India

To diagnose isolated tuberculosis of the sternum in patients presenting with signs and symptoms suggestive of tuberculosis. A prospective study conducted at Jawaharlal Nehru Medical College [JNMC] Hospital, Aligarh, India from July 2000 to July 2006 of 2512 patients presenting with a suspected case of tuberculosis. Cases were confirmed using different investigations along with treatment of the patients with antitubercular treatment [ATT], with further follow up for next 2 years. Nineteen patients were suffering from isolated tuberculosis of sternum. The main presenting feature was retrosternal discomfort [100%] while 14 [73.6%] patients presented with a cold abscess of sternum. All the patients were treated successfully with 12 months of ATT and followed up for 2 years for any relapse. Although tuberculosis of sternum is rare, it should be considered as an important differential diagnosis in patients presenting with chronic lesions of the sternum, particularly in endemic/developing countries. Twelve months of treatment with ATT is optimal for achieving cure without any risk of relapse

Drug resistant tuberculous osteomyelitis of small bones of foot.

Drug resistant tubercular osteomyelitis of small bones of foot is not reported frequently. The case described here had isoniazid resistant tuberculous osteomyelitis of small bones of foot. The probable mechanism was endogenous reactivation of previously disseminated foci of drug resistant bacilli from the primary site in the lung.

Extraspinal osteoarticular tuberculosis: a forgotten entity? / La Tuberculosis Osteoarticular Extraespinal ¿Una Entidad Olvidada?

Tuberculosis affects a significant percentage of the world's population and is responsible for bone and joint infections particularly in the developing world. The problem has been compounded by the HIV/ AIDS epidemic. Whereas tuberculous involvement of the spine is readily included in a list of differentials for destructive lesions of the spine, infection in other skeletal areas is often not considered. In endemic areas, physicians are aware of the clinical and radiological presentations of musculoskeletal tuberculosis. In non-endemic areas, this knowledge is often lacking. Diagnostic delay often results in increased morbidity and mortality. There is a need therefore to highlight extra-spinal osteoarticular tuberculosis as a real entity

La tuberculosis afecta a un porcentaje significativo de la población mundial, y es causa de infecciones en los huesos y las articulaciones, particularmente en los países en vías de desarrollo. El problema ha sido agravado por la epidemia del HIV/AIDS. Mientras que la tuberculosis vertebral suele incluirse con prontitud en la lista de diagnósticos diferenciales de las lesiones destructivas de la columna vertebral, la infección en otras áreas de la estructura ósea a menudo se pasa por alto. En las regiones endémicas, los médicos conocen las manifestaciones clínicas y radiológicas de la tuberculosis músculoesqueletal. En las regiones no endémicas, este conocimiento está a menudo ausente. Con frecuencia, la demora en el diagnóstico trae como consecuencia una mayor morbosidad y mortalidad. Por lo tanto, se hace necesario prestar atención a la tuberculosis osteoarticular extraespinal como una entidad real

Tuberculosis of the sternoclavicular joint.

A rare case of tuberculosis of the stemoclavicular joint in a 13-year-old girl is presented. The occurrence of tubercular infection in the sternoclavicular joint is extremely rare.

Epidemiologia da tuberculose óssea: análise de 149 casos no Paraná / Epidemiology of bone tuberculosis: analysis of 149 cases in the state of Paraná, Brazil

Uma análise retrospectiva foi realizada com 12.053 pacientes portadores de tuberculose entre julho de 1988 e dezembro de 1992, tendo sido encontrados 149 cujo foco era osteoarticular. Dentre estes 149 pacientes, foram determinadas algumas características epidemiológicas, tais como: dados demográficos, local de origem, tratamento anterior para tuberculose, cicatriz vacinal por BCG, contato com pacientes portadores de tuberculose, bacterioscopia do escarro para BAAR, resultado do teste tuberculínico, achados no raio X de tórax, ano do diagnóstico inicial e tratamento instituído. Todos os pacientes incluídos neste estudo encontravam-se residindo no Estado do Paraná na época do diagnóstico. Os resultados demonstraram que a maioria dos pacientes era homem, branco, estava na quarta década de vida, morava no leste do Estado do Paraná, sem tratamento prévio para tuberculose, sem cicatriz vacinal, sem contato conhecido com pacientes portadores de tuberculose e recebeu tratamento com o esquema tríplice padronizado (rifampicina + pirazinamida + isoniazida). Näo houve tendência ao aumento ou decréscimo na sua incidência nos anos observados.

Osteoarticular tuberculosis in children.

One hundred and four cases of osteoarticular tuberculosis were studied. There were 74 boys (71.2%) and 30 girls (28.8%). The mean age at the onset of symptoms was 7.3 years, ranging from 9 months to 18 years. Seventy four cases (71%) reported 3 months after onset of symptoms. The spine was the commonest site involved (43%) followed by hip (14.9%) and knee joints (10.3%). Evidence of active or inactive pulmonary tuberculosis was found in 16.2%. All cases were treated by three drug regimen of rifampicin, isoniazid and ethambutol; rifampicin was discontinued after 6 months, ethambutol after 12-14 months. In 12 cases (11.5%) isoniazid was continued for 18 months. Along with chemotherapy suitable braces, splints, tractions, exercises and other form of physical therapy produced satisfactory results. Seventy eight patients (75%) showed clinical and radiological improvement with one year of treatment. The follow up period ranged between 4 months to 24 months with an average of 17 months. Children because of capacity to grow, showed progressive deformity in knee in 3 cases (2.8%), hip in 98 cases (8.6%), shortening of limbs in 14 cases (13.4%) and kyphosis in 13 cases (12.5%).

Tuberculosis osteoarticular en el Hospital Nacional Edgardo Rebagliati Martins / Osteoarticular tuberculosis in Hospital Nacional Edgardo Rebagliati Martins (HNERM)

Se realizó un estudio retrospectivo sobre tuberculosis osteoarticular en el Hospital Nacional "Edgardo Rebagliati Martins" (HNERM), en el período de 1975-1985. De los 66 pacientes estudiados (39 hombres y 27 mujeres) con un rango de 11-76 años de edad, más del 50 por ciento eran menores de 40 años. La tuberculosis osteoarticular fue el 1.58 por ciento del total de casos de tuberculosis atendidos, ocupando el tercer lugar entre las tuberculosis extrapulmonares. Existe retardo en el diagnóstico, en más del 25 por ciento se hizo después de 18 meses de iniciada la enfermedad. Las localizaciones más frecuentes fueron: columna (30 por ciento), rodilla (30 por ciento) y cadera (17 por ciento). El traumatismo fue el factor predisponente más frecuente. De las formas clínicas de tuberculosis osteoarticular, la monoartritis es más frecuente (54.6 por ciento), seguida por espondilitis (34.8 por ciento), oligoartritis (6.4 por ciento), poliartritis (1.6 por ciento); siendo dolor la manifestación común a todas ellas. La radiología típica fue de gran utilidad para el diagnóstico y, la artroscopía, en los casos de monoartritis de rodilla. Desde fines de 1981, el empleo de 4 drogas ha permitido acortar el tiempo de tratamiento (de 18-24 meses a 12-14 meses).