[Tuberculous abscess of the posterior thigh: report of a case]

Upper Paleolithic tuberculosis: A probable case illustrated by paleoimaging methods (Azilian site of Les Iboussières, France)

The aim of this paper is to present the results of μCT-scan and 3D imaging analyses of two skeletal lesions observed on human remains of one of the last European hunter-gatherers from the late Paleolithic (Azilian period): a sacroiliac osteoarthritis and a femoral lesion suggestive of a soft tissue abscess imprint. These two skeletal elements (fused left sacrum and coxal bone, and right femur) displayed osteometric criteria indicating that they belonged to the same individual. These two associated lesions are consistent with a low-grade osteoarticular infection, and suggest a diagnosis of pelvic tuberculosis with a cold abscess of the thigh. If molecular confirmation is obtained, this case would be the first evidence of tuberculosis among Upper Palaeolithic populations.

Case Report: Tuberculous abscess of the popliteal fossa: A case report

Introduction Tuberculosis of the soft tissues is a rare form of extra pulmonary tuberculosis, and isolated localization in the popliteal fossa is particularly exceptional. Atypical clinical presentation can lead to delayed diagnosis and serious complications. Case report We report the case of a 17-year-old patient who was diagnosed with tuberculosis of the popliteal fossa. He presented with a painful inflammatory swelling of the right popliteal fossa associated with a homolateral inguinal lymph node, without knee joint effusion. Standard chest and knee X-rays were normal, while MRI showed an 8 cm well vascularized, partly liquefied mass in the popliteal fossa, developed in contact with the semimembranosus and medial gastrocnemius muscles, associated with a popliteal lymph node without synovial effusion or thickening. Microbiological tests did not isolate any germs. The diagnosis was made on histological examination after biopsy, which revealed a caseous granuloma surrounded by epithelioid cells. The patient was treated with anti-tuberculosis therapy for 9 months. The clinical and radiological regression of the swelling was observed without recurrence at 2 years of follow-up. Conclusion Any soft tissue abscess should raise suspicion of tuberculosis, especially in endemic countries. The importance of histopathological examination should be emphasized to establish the diagnosis in the absence of signs in favor of a primary localization.

Unusual cervicofacial localization of two subcutaneous tuberculous cold abscesses in an immunocompetent subject

Introduction

Subcutaneous tuberculous cold abscesses represent a rare form of extra-pulmonary tuberculosis and their cervicofacial localization is exceptional. The management of this unusual form and location is medico-surgical and must be adapted to avoid progression to complications.

Case report

We report the case of a double cervicofacial localization of subcutaneous tuberculous cold abscesses in an immunocompetent patient followed for pulmonary tuberculosis who benefited from a surgical drainage of the two abscesses with anti-tuberculosis treatment with good clinical evolution.

Discussion

The diagnosis of subcutaneous tuberculous cold abscesses is based on a combination of anamnestic, clinical and paraclinical findings. Cold abscesses are most commonly described in patients with disseminated tuberculosis or during human immunodeficiency virus infection, but they may also occur in immunocompetent subjects. Monofocal localization is the most common and the association of several localizations is unusual. The treatment is medical-surgical, combining surgical drainage with anti-tuberculosis treatment.

Conclusion

Subcutaneous tuberculous cold abscesses should be considered in the presence of any stubborn collection occurring in a context of tuberculosis infection. Early diagnosis is the best guarantee of a cure without complications.

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Subcutaneous tuberculous cold abscess is a rare presentation of extra-pulmonary tuberculosis.

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Cervico-facial localization is exceptional.

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The association of two locations is unusual.

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The diagnosis requires the comparison of a set of anamnestic, clinical and paraclinical arguments.

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The therapeutic management must be adapted to avoid the evolution towards complications.