Surgical Management of Thoracolumbar Scoliosis Secondary to Hip Joint Ankylosis and Severe Pelvic Obliquity.

We report a rare case of a rigid spinal deformity with severe pelvic obliquity (PO) resulting from hip ankylosis caused by childhood tuberculosis (TB). A 66-year-old woman presented with left knee pain, chronic low back pain, and fatigability during walking. She presented with leg length discrepancy (LLD) due to an ankylosed right hip joint, severe PO, and secondary lumbar scoliosis. Total hip arthroplasty (THA) and adductor tendonectomy were performed prior to spine surgery, and posterior spinal correction and fusion were performed from T10 to the pelvis. Prior to spinal correction surgery, we predicted that it would be impossible to make the pelvis perfectly horizontal. Therefore, we positioned a prosthetic acetabular cup at a small inclination angle at the upper limit of anteversion; spinal correction and fusion were then performed. Her symptoms including fatigability during walking resolved and the sagittal spinal balance on standing improved dramatically. The preoperative and postoperative values of the thoracolumbar Cobb angle was 40° and 25°, lumbosacral Cobb angle was 60° and 14°, C7 plumb line shift was 24 and 0 mm, pelvic tilt was 15° and 19°, lumbar lordosis (LL) was 23° and 60°, pelvic incidence minus lumbar lordosis (PI-LL) was 38° and 1°, the sagittal vertical axis was 80 and 0 mm, and PO was 28° and 15°, respectively. We present a case of rigid spinal deformity accompanied by hip joint ankylosis and PO. Performing THA prior to spinal correction surgery is an alternative and feasible option for the treatment of this challenging pathology.

Primary patella tuberculosis mimicking pre-patellar bursitis: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: The Patella is very rare site for tuberculosis (TB). The knee is the third most common site for skeletal TB. The incidence of patella TB being 0.09 to 0.15%. CASE PRESENTATION: We report a case of primary tuberculous osteitis isolated from the patella. The complaint was a mixed knee pain without notion of trauma. The CT showed a large osteolysis of the upper half of the patella. The diagnosis was established on the histological study after biopsy. The patient was operated by a medial approach without arthrotomy and the pathological tissue was resected and curetted. Complementary anti-bacillary antibiotic treatment was administered for 12 months. At the last clinical control, the knee was free and painless, and we had no recurrence. CLINICAL DISCUSSION: Aitken reported the first case in literature in 1933. The initial signs and symptoms are non-specific and sometimes confounded by a coincidental history of trauma. It is difficult to diagnose TB of patella in early stages because there are no constitutional symptoms. Sometimes serological parameters are inconclusive. CT scan can help if the osteolysis contained a central bone sequestration, bordered by peripheral sclerosis. Confirmation of patellar tuberculosis is made on biopsy. CONCLUSION: The tuberculous localization in the patella is rare and it can pose a problem of differential diagnosis with other affections, in particular infectious and tumors. It should always be kept in mind, especially in the face of a picture of pre-patellar bursitis which progresses slowly and whose biological inflammatory syndrome is not straightforward.

Late Discovering Spina Ventosa: A Case Report.

INTRODUCTION: Spina Ventosa is a rare condition that is easy to misdiagnose as other diseases. We present a case of late-diagnosed Spina Ventosa, which had not only the osteoarticular tuberculosis symptoms but also some severe symptoms, including pleural effusion, ascites, and anemia. By intensive treatment, our patient recovered completely. CASE REPORT: A 7-year-old boy was admitted with complaints of painless swelling of metacarpals, metatarsals, and phalanges of his hands and feet and a discharging sinus of the left toe. There was no family or past history of tuberculosis. His immunizations were up to date. General examination revealed that the child had pallor and was emaciated. No lymphadenopathy was detected. Investigations revealed hemoglobin: 74 g/l, and erythrocyte sedimentation rate (ESR) was 42 mm/hour. QuantiFERON-TB test was positive. The radiograph showed irregular swelling with sclerosis of the underlying bones. The right-hand x-ray showed cortical destruction, sclerosis, and cystic expansion or right second metacarpal. Chest x-ray indicated pleural effusion. Histopathological examination of specimen from the foot and lung and abdomen fluid confirmed tuberculosis. The child was treated with the first-line tuberculosis treatment regimen (Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide) for two months, followed by Isoniazid, Rifampicin, and Pyrazinamide for a further four months. His lesions disappeared after six weeks of intensive treatment. CONCLUSION: A delay in diagnosis and treatment of tuberculosis can lead to systemic manifestations in multiple organs. Despite the delay in diagnosis, this child had a good outcome due to being treated promptly and adequately after the presentation.

Multifocal Tubercular Dactylitis: A Rare Presentation of Skeletal Tuberculosis in an Adult.

Tubercular dactylitis is an uncommon form of osteo-articular tuberculosis seen in children. Multifocal involvement, simultaneously involving hands and feet is extremely uncommon. Here we report an adult patient with tubercular dactylitis involving multiple digits of both hands and second digit of right foot in absence of any risk factors like immunodeficiency or any debilitating condition. The patient was successfully treated with anti-tubercular drugs for six months. Mycobacterium tuberculosis infection of bones and joints can present in an unusual way but early diagnosis and treatment caries a good prognosis.

Cutaneous and articular tuberculosis in a renal transplant recipient

Abstract Seven months after undergoing kidney transplantation, a 56-year-old woman presented with papules and ulcers in her right forearm. The patient received antibiotics for 8 months with limited improvement. Eleven months after symptom onset, she presented with acute arthritis in her left knee. Asynovial fluid culture yielded Mycobacterium tuberculosis, and a forearm ulcer biopsy showed granulomatous inflammation. After surgical fistulectomy and 12 months of tuberculosis treatment, she was cured. Chronic cutaneous ulcers and articular manifestations in TB are rare, but they should always be considered in the differential diagnosis for immunosuppressed patients. Surgical intervention and prolonged treatment might be necessary.

Clinical and diagnostic features of trochanteric tuberculosis.

Trochanteric tuberculosis is a very rare localization of musculo-skeletal tuberculosis. The diagnosis is difficult and is often made in a late stage. The authors describe five cases of trochanteric tuberculosis. The mean age of patients was 46.6 years. Time to diagnosis was long (7.6 months on average). The tuberculosis was plurifocal in all cases. Diagnosis was based on positive Lowenstein culture in one case, on the presence of caseum granuloma in one case and through a pathognommonic manifestation in one case. For the remaining two cases, diagnosis was established on clinical and paraclinical arguments. The patients recovered after medical treatment alone.