[Dorsolumbar cold abscess revealing Pott's disease]

[Multiple tuberculous cold abscesses associated with Pott's disease in an immunocompetent patient with cervical localization in Burkina Faso]

Introduction

Cervical Pott's disease is a very rare localization of bone tuberculosis. Its association with cercico-thoracic cold abscesses is also exceptional.

Observation

A 36-year-old black African patient of Burkinabè origin, with a history of tuberculosis infection (his mother had pulmonary tuberculosis) and no other pathological history, presented with chronic inflammatory cervicalgia that had been developing for six months in a non-febrile context of altered general condition. Examination showed a left latero-cervical swelling associated with a left basithoracic swelling, both fluctuant. Pleuropulmonary and neurological examinations were normal. HIV serology and tuberculin skin test were negative. Cervico-thoracic computed tomography revealed multiple abscesses. The abscesses were incised and drained. Analysis of the specimen showed the presence of acid-fast bacilli by direct examination and Mycobacterium tuberculosis by Xpert test, with sensitivity to rifampicine. The diagnosis was multiple tuberculous cold abscesses associated with cervical Pott's sore. The patient was started on standard analgesics and antituberculosis drugs for 12 months. The course was favorable, with a follow-up of one year after treatment.

Conclusion

Cold cervical abscess complicating Pott's disease is exceptional. Imaging and the geneXpert assay are now rapid and effective diagnostic tools for tuberculosis. This particular form should always be suspected in endemic areas.

Tuberculoma with phlegmon-like symptoms mimicking soft tissue sarcoma in the wrist: A case report

Despite the increasing incidence of tuberculosis, even in developed countries like Japan, tuberculoma is a relatively uncommon disease. Furthermore, given the rarity of tuberculoma, a definitive diagnosis is often delayed. We herein present the case of a 79-year-old man who presented with an erythematous and warm mass in the left forearm. Radiography revealed calcification of the wrist's volar side, and magnetic resonance imaging revealed a mosaic pattern at the lesion. Soft tissue sarcoma of the wrist was suspected, and an incisional biopsy was performed, which revealed numerous yellow rice bodies. A rapid pathological evaluation revealed caseous necrosis and Langhans giant cells, and a histological evaluation confirmed the diagnosis of tuberculoma. All the rice bodies were resected and the patient received postoperative antibiotic treatment with pyrazinamide, isoniazid, rifampicin and ethambutol. However, the patient developed hepatic insufficiency during treatment, and the regimen was discontinued. The patient had not experienced recurrence 1 year after the treatment. In conclusion, tuberculoma should be considered in the differential diagnosis of a wrist mass mimicking an inflamed soft tissue tumor.