ABSTRACT
Introducción. La tuberculosis osteoarticular en niños es una condición infrecuente que representa un pequeño porcentaje de las infecciones extrapulmonares por Mycobacterium tuberculosis.Presentación del caso. Niño de 30 meses con antecedente de que COVID-19 que fue llevado al servicio de urgencias por dolor en la marcha, imposibilidad para la bipedestación y dolor severo en posición decúbito. El paciente tenía niveles de reactantes de fase aguda elevados y mediante tomografía computarizada y resonancia magnética nuclear se evidenció destrucción de L3 con pérdida de la médula ósea, colapso vertebral y colección de fluido, así como compromiso de L4. Posteriormente, en una biopsia abierta se encontró colección de fluido con secreción, con resultado negativo en cultivos de bacterias y resultado positivo en prueba molecular de detección de Mycobacterium tuberculosis. Una semana después del ingreso, se inició manejo farmacológico antituberculoso y se inmovilizó con ortesis toracolumbosacra. En un nuevo ingreso al servicio de urgencias, se realizó drenaje quirúrgico por dehiscencia de la herida, secreción y febrícula. Sin embargo, en un control posterior se encontró espondilodiscitis en L3 y L4, y abscesos epidurales. Finalmente, una vez terminado el manejo con ortesis, en un último control se observó que el paciente presentaba cifosis toracolumbar residual, pero no tenía signos de compromisos radicular o medular, ni de déficit osteoarticular.Conclusión. La tuberculosis vertebral es una condición infrecuente en población pediátrica, por lo que es importante tener una sospecha clínica en todos los niños con síntomas típicos de la enfermedad.
Introduction: Osteoarticular tuberculosis in children is a rare condition that accounts for a small percentage of extrapulmonary Mycobacterium tuberculosis infections. Case presentation: A 30-month-old boy with a history of COVID-19 was taken to the emergency department due to antalgic pain, inability to stand up straight, and severe pain in decubitus position. The patient had elevated acute phase reactants levels, and computed tomography and magnetic resonance imaging showed destruction of L3 with bone marrow loss, vertebral collapse, and fluid collection, as well as involvement of L4. An open biopsy showed fluid collection with secretion, negative bacterial cultures, and positive molecular test for Mycobacterium tuberculosis. One week after admission, antitubercular pharmacological treatment was started and the patient was immobilized with a thoracolumbosacral orthosis. In a new admission to the emergency department, surgical drainage was performed due to wound dehiscence, secretion, and low-grade fever. However, in a subsequent follow-up, spondylodiscitis was found at L3 and L4, as well as epidural abscesses. Finally, once the orthosis management was completed, during a last follow-up, it was observed that the patient had residual thoracolumbar kyphosis, but no signs of radicular or spinal cord involvement, or osteoarticular deficit.Conclusion: Spinal tuberculosis is a rare condition in the pediatric population, so clinical suspicion in all children with typical symptoms of the disease is always important
ABSTRACT
Acute massive rotator cuff tears and posterior shoulder dislocations are an extremely rare association, and a vast majority are treated by open surgery. We present a case of a man in his 20s who suffered closed left shoulder trauma after a road traffic accident. He was initially diagnosed with posterior shoulder dislocation and a reduction was successfully performed. However, the patient still complained of persistent weakness during active movements. We found a massive rotator cuff tear involving all the rotator cuff tendons, with significant supraspinatus retraction and persistent posterior shoulder subluxation. He underwent an all-arthroscopic repair of the rotator cuff with a double-row technique in the subscapularis, supraspinatus and infraspinatus muscles. Capsular repair and tenodesis of the biceps tendon were also performed. The patient had good recovery, reaching full preinjury function 3 months after surgery with a successful return to his regular activities.
