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Bezabih NA, Mulugeta M, Bezabih BA, Gidena EK. Early presentation of mycetoma (Madura Foot): A case report. Radiol Case Rep 2024; 19:3354-3357. [PMID: 38827041 PMCID: PMC11143775 DOI: 10.1016/j.radcr.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
Mycetoma, commonly known as Madura foot, is a chronic and progressively destructive granulomatous disease caused by a fungus or anaerobic filamentous bacteria that affects the skin, subcutaneous tissue, and bones primarily in tropical and subtropical regions, with males between the ages of 20-40 having occupational exposure to outdoor environments, such as farming, predominantly affected. It is one of the World Health Organization's 17 "neglected tropical diseases," characterized by a clinical trial of localized mass-like soft tissue injury with draining sinuses that discharge grains of infectious material. Here, we present a case report of a 40-year-old male with type 2 diabetes mellitus and a history of fieldwork, who exhibited early manifestations of mycetoma. Unlike the typical diffuse presentation seen in advanced cases, this patient's early presentation prompted diagnostic challenges due to its atypical nature. We highlight the importance of recognizing the early signs of mycetoma, particularly in individuals with predisposing factors such as diabetes and occupational exposure. Diagnostic dilemmas may arise, leading to potential misdiagnosis. Additionally, we emphasize the crucial role of biopsy in confirming the diagnosis, alongside imaging techniques, to facilitate timely intervention and management, thereby significantly impacting patient outcomes.
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Affiliation(s)
- Natnael Alemu Bezabih
- Department of Radiology, Addis Ababa University, College of Health Sciences, 2P9X+MF8, Addis Ababa, Ethiopia
| | - Mesfin Mulugeta
- Department of Radiology, Addis Ababa University, College of Health Sciences, 2P9X+MF8, Addis Ababa, Ethiopia
| | - Bezawit Alemu Bezabih
- Department of Radiology, Addis Ababa University, College of Health Sciences, 2P9X+MF8, Addis Ababa, Ethiopia
| | - Eden Kahsay Gidena
- Department of Radiology, Addis Ababa University, College of Health Sciences, 2P9X+MF8, Addis Ababa, Ethiopia
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Çay Ü, Alabaz D, Gündeşlioglu ÖÖ, Mirioglu A, Pehlivan UA. Skeletal Tuberculosis in Pediatric Population for 15 Years; Twenty Cases from Southern Turkey. Niger J Clin Pract 2023; 26:1602-1609. [PMID: 38044761 DOI: 10.4103/njcp.njcp_699_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 07/21/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Skeletal tuberculosis is rarely seen among extrapulmonary tuberculosis, especially in childhood because the diagnosis may be delayed for years due to diagnostic difficulties. In this study, it was aimed to evaluate the clinical characteristics, methods used in diagnosis, treatment specifics, and prognosis of patients diagnosed with bone joint tuberculosis in childhood. MATERIALS AND METHODS Twenty patients diagnosed with skeletal tuberculosis in our hospital between Jan 1, 2006, and Jan 1, 2021, were evaluated retrospectively. RESULTS The age of the patients ranged from seven to 191 months. 70% of the patients presented with complaints of pain, 50% with swelling, and 20% with limping. The duration of the complaints was 3.82 ± 4 months on average. While 65% of the patients had isolated skeletal TB, 30% were accompanied with pulmonary tuberculosis. Tuberculin skin test (TST) was positive in 13 (65%) patients. Seven (35%) of the patients were diagnosed with proven TB. The most frequent involvement was seen in knee bones (25%), followed by vertebra (15%), foot (15%), and wrist (15%) bones. In the radiological findings, 65% of the patients had mass, 45% destruction, 35% enhancement/edema, 5% calcification/sclerosis, 5% cyst, and 35% soft tissue abscess. In the follow-up, 50% of the patients recovered without sequelae. CONCLUSION Skeletal tuberculosis can easily be missed in childhood due to its slow insidious course, non-specific symptoms, and bone findings, resulting in delayed diagnosis and may lead to sequelae which affect lifelong quality of life. We should keep the possibility of skeletal tuberculosis in mind when we see the patients with limping or localized lesions accompanied with pain or swelling.
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Affiliation(s)
- Ü Çay
- Department of Pediatric, Pediatric Infectious Diseases, Çukurova University, Adana, Turkey
| | - D Alabaz
- Department of Pediatric, Pediatric Infectious Diseases, Çukurova University, Adana, Turkey
| | - Ö Ö Gündeşlioglu
- Department of Pediatric, Pediatric Infectious Diseases, Çukurova University, Adana, Turkey
| | - A Mirioglu
- Department of Orthopedics and Traumatology, Çukurova University, Adana, Turkey
| | - U A Pehlivan
- Radiology, Faculty of Medicine, Çukurova University, Adana, Turkey
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Marais L, Nieuwoudt L, Nansook A, Menon A, Benito N. Tuberculous arthritis of native joints - a systematic review and European Bone and Joint Infection Society workgroup report. J Bone Jt Infect 2023; 8:189-207. [PMID: 37780528 PMCID: PMC10539782 DOI: 10.5194/jbji-8-189-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/23/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction: The aim of this systematic review was to assess the existing published data on the diagnosis and management of tuberculosis (TB) arthritis involving native joints in adults aged 18 years and older. Methods: This study was performed in accordance with the guidelines provided in the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Results: The systematic review of the literature yielded 20 data sources involving 573 patients from nine countries. There was considerable variation amongst the studies in terms of the approach to diagnosis and management. The diagnosis was mostly made by microbiological tissue culture. Medical management involved a median of 12 months of anti-tubercular treatment (interquartile range, IQR, of 8-16; range of 4-18 months). The duration of preoperative treatment ranged from 2 to 12 weeks. Surgery was performed on 87 % of patients and varied from arthroscopic debridement to complete synovectomies combined with total joint arthroplasty. The mean follow-up time of all studies was 26 months (range of 3-112 months). Recurrence rates were reported in most studies, with an overall average recurrence rate of approximately 7.4 % (35 of 475 cases). Conclusions: The current literature on TB arthritis highlights the need for the establishment of standardized guidelines for the confirmation of the diagnosis. Further research is needed to define the optimal approach to medical and surgical treatment. The role of early debridement in active TB arthritis needs to be explored further. Specifically, comparative studies are required to address questions around the use of medical treatment alone vs. in combination with surgical intervention.
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Affiliation(s)
- Leonard C. Marais
- Department of Orthopaedic Surgery, School of Clinical Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Durban 4001, South Africa
| | - Luan Nieuwoudt
- Department of Orthopaedic Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Grey's Hospital, Townbush Road, Pietermaritzburg 3201, South Africa
| | - Adisha Nansook
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Avenue, Cape Town 7505, South Africa
| | - Aditya Menon
- Department of Orthopaedics, P. D. Hinduja Hospital and Medical Research Centre, Mahim, Mumbai, India
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia
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Vinogradova TI, Serdobintsev MS, Korzhikova-Vlakh EG, Korzhikov-Vlakh VA, Kaftyrev AS, Blum NM, Semenova NY, Esmedlyaeva DS, Dyakova ME, Nashchekina YA, Dogonadze MZ, Zabolotnykh NV, Yablonsky PK. Comparison of Autografts and Biodegradable 3D-Printed Composite Scaffolds with Osteoconductive Properties for Tissue Regeneration in Bone Tuberculosis. Biomedicines 2023; 11:2229. [PMID: 37626725 PMCID: PMC10452435 DOI: 10.3390/biomedicines11082229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Tuberculosis remains one of the major health problems worldwide. Besides the lungs, tuberculosis affects other organs, including bones and joints. In the case of bone tuberculosis, current treatment protocols include necrectomy in combination with conventional anti-tuberculosis therapy, followed by reconstruction of the resulting bone defects. In this study, we compared autografting and implantation with a biodegradable composite scaffold for bone-defect regeneration in a tuberculosis rabbit model. Porous three-dimensional composite materials were prepared by 3D printing and consisted of poly(ε-caprolactone) filled with nanocrystalline cellulose modified with poly(glutamic acid). In addition, rabbit mesenchymal stem cells were adhered to the surface of the composite scaffolds. The developed tuberculosis model was verified by immunological subcutaneous test, real-time polymerase chain reaction, biochemical markers and histomorphological study. Infected animals were randomly divided into three groups, representing the infection control and two experimental groups subjected to necrectomy, anti-tuberculosis treatment, and plastic surgery using autografts or 3D-composite scaffolds. The lifetime observation of the experimental animals and analysis of various biochemical markers at different time periods allowed the comparison of the state of the animals between the groups. Micro-computed tomography and histomorphological analysis enabled the evaluation of osteogenesis, inflammation and cellular changes between the groups, respectively.
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Affiliation(s)
- Tatiana I. Vinogradova
- Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation, Ligovskiy pr. 2–4, St. Petersburg 191036, Russia; (T.I.V.); (M.S.S.); (A.S.K.); (D.S.E.); (M.E.D.); (M.Z.D.); (N.V.Z.); (P.K.Y.)
| | - Mikhail S. Serdobintsev
- Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation, Ligovskiy pr. 2–4, St. Petersburg 191036, Russia; (T.I.V.); (M.S.S.); (A.S.K.); (D.S.E.); (M.E.D.); (M.Z.D.); (N.V.Z.); (P.K.Y.)
| | - Evgenia G. Korzhikova-Vlakh
- Institute of Macromolecular Compounds, Russian Academy of Sciences, Bolshoy pr. 31, St. Petersburg 199004, Russia;
| | - Viktor A. Korzhikov-Vlakh
- Institute of Macromolecular Compounds, Russian Academy of Sciences, Bolshoy pr. 31, St. Petersburg 199004, Russia;
- Institute of Chemistry, Saint-Petersburg State University, Universitetskiy pr. 26, St. Petersburg 199034, Russia
| | - Alexander S. Kaftyrev
- Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation, Ligovskiy pr. 2–4, St. Petersburg 191036, Russia; (T.I.V.); (M.S.S.); (A.S.K.); (D.S.E.); (M.E.D.); (M.Z.D.); (N.V.Z.); (P.K.Y.)
| | - Natalya M. Blum
- Department of Pathological Anatomy, S.M. Kirov Military Medical Academy, Botkinskaya str. 21/2, St. Petersburg 194044, Russia;
| | - Natalya Yu. Semenova
- Interregional Medical Center, Oleko Dundich str. 8/2, St. Petersburg 192283, Russia;
| | - Dilyara S. Esmedlyaeva
- Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation, Ligovskiy pr. 2–4, St. Petersburg 191036, Russia; (T.I.V.); (M.S.S.); (A.S.K.); (D.S.E.); (M.E.D.); (M.Z.D.); (N.V.Z.); (P.K.Y.)
| | - Marina E. Dyakova
- Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation, Ligovskiy pr. 2–4, St. Petersburg 191036, Russia; (T.I.V.); (M.S.S.); (A.S.K.); (D.S.E.); (M.E.D.); (M.Z.D.); (N.V.Z.); (P.K.Y.)
| | - Yulia A. Nashchekina
- Institute of Cytology, Russian Academy of Sciences, Tikhorezkii pr. 4, St. Petersburg 194064, Russia;
| | - Marine Z. Dogonadze
- Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation, Ligovskiy pr. 2–4, St. Petersburg 191036, Russia; (T.I.V.); (M.S.S.); (A.S.K.); (D.S.E.); (M.E.D.); (M.Z.D.); (N.V.Z.); (P.K.Y.)
| | - Natalia V. Zabolotnykh
- Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation, Ligovskiy pr. 2–4, St. Petersburg 191036, Russia; (T.I.V.); (M.S.S.); (A.S.K.); (D.S.E.); (M.E.D.); (M.Z.D.); (N.V.Z.); (P.K.Y.)
| | - Petr K. Yablonsky
- Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation, Ligovskiy pr. 2–4, St. Petersburg 191036, Russia; (T.I.V.); (M.S.S.); (A.S.K.); (D.S.E.); (M.E.D.); (M.Z.D.); (N.V.Z.); (P.K.Y.)
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Encountering pelvic tuberculosis in closed pelvic ring injury with distant wound - An intraoperative surprise: A case report. Trauma Case Rep 2023; 44:100784. [PMID: 36844022 PMCID: PMC9945763 DOI: 10.1016/j.tcr.2023.100784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
Delayed presentation of closed APC type III pelvic ring injury with a healing wound on the medial thigh, in a twenty-six-year-old male, at four weeks. We planned Symphyseal plating and sacroiliac screw fixation surgery. After percutaneous screw fixation, subsequent pelvic exposure revealed whitish cheesy pus in the retropubic space. Hence, we changed surgery from internal fixation to a supra-acetabular external fixator. Subsequent molecular testing documented tuberculosis and regimen of antitubercular medications was started. Complete functional recovery was observed at 12 months. While managing pelvic injuries, alternative backup treatment plans should be kept ready in view of infective foci.
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Lad P, Tanpure S, Phadnis A. Tuberculosis of hand and wrist: Varied clinical presentation and functional outcome by surgical intervention in 13 cases. Indian J Tuberc 2023; 70:17-22. [PMID: 36740312 DOI: 10.1016/j.ijtb.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/29/2022] [Indexed: 02/07/2023]
Abstract
A prospective study of 13 cases with tuberculosis of hand and wrist was presented with mean age of patients being 42.7 years (range 18 months to 84 years). Pain, swelling and difficulty in movement of adjacent joints were the most common presenting complaints. The discharging sinus, abscess & nerve compression were also observed in some cases. Out of 13 cases, bone involvement was seen in one case, joint involvement in five cases, soft tissue involvement in five cases and two cases had both soft tissue and joint involvement. All patients had undergone operative intervention for confirmation of diagnosis and improvement in function. Surgeries like open biopsy, debridement and tenosynovectomy were performed. Depending upon drug sensitivity on culture and histopathology report, standard anti-tuberculous treatment (ATT) was commenced under supervision of Infection Disease expert. Hand function was evaluated by modified Green and O'Brian score. The mean score was 58.84 (35-70) before any intervention and it improved to 89.23 (60-100) at 6 months follow up after surgical intervention and ATT. In conclusion, surgery may help for early functional recovery and for encouraging patient to use their hand for activities of daily living.
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Affiliation(s)
- Parag Lad
- Department of Orthopaedics, Jupiter Hospital, C-1004, Flora CHS Ltd, Hiranandani Estate, G B Road, Thane(W), MH, 400607, India
| | - Sanket Tanpure
- Senior Resident, Vithalrao Vikhe Patil Medical College, Ahmednagar, India.
| | - Ashish Phadnis
- Orthopaedic OPD Jupiter Lifeline Hospital, 1st Floor, Thane, MH, 400601, India
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Risos K, Duggal NA, Kamath S, Wolberg A, Sundaresh KK. A Case of Posttraumatic Pott’s Disease. Cureus 2022; 14:e26380. [PMID: 35911313 PMCID: PMC9329150 DOI: 10.7759/cureus.26380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Tuberculosis infection, which is caused by the bacterium Mycobacterium tuberculosis (Mtb), most commonly manifests in patients with respiratory systems. However, it can also colonize other tissues including skeletal. In our case, a 77-year-old Caucasian male presented to the emergency department following a rollover motor vehicle collision with chief complaints of neck and lower back pain. After clinical improvement and a preliminary negative workup, the patient was deemed stable for discharge. Four months later, the patient was subsequently admitted for worsening back pain with workup suspicious for T9 and T10 discitis osteomyelitis and abscess formation on computed tomography (CT). During this admission, spinal Mtb was confirmed by acid-fast stain and real-time polymerase chain reaction of a CT-guided disc space aspirate of a left paraspinal cystic collection at approximately T9-T10. Given these findings, the patient was subsequently put on standard four-drug therapy for Mtb. Our case demonstrates the importance of considering Pott’s disease in the diagnosis of lumbar spinal pain, especially in patients living in areas with high international migration and travel.
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8
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Jain VK, Iyengar KP, Rana N, Agarwal A, Botchu R. Tuberculosis of ischial tuberosity as a rare cause of gluteal pain: A case series of 9 patients with review of literature. J Clin Orthop Trauma 2022; 28:101852. [PMID: 35402154 PMCID: PMC8991308 DOI: 10.1016/j.jcot.2022.101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Osteo-articular Mycobacterium tuberculosis infection of the ischial tuberosity is a rare cause of gluteal pain. METHODS A retrospective clinico-radiological review of nine patients with Mycobacterium tuberculosis infection of the ischial tuberosity was undertaken. The spectrum of presenting features, diagnostic challenges, radiological findings with particular emphasis on Magnetic resonance imaging (MRI) and clinical course was reviewed. RESULTS All the 9 patients (5 male: 4 female) aged between 8 and 50 years of age (mean 15.3 years) developed insidious onset of buttock pain over a period of weeks to months with difficulty in walking. Microbiological and/or histopathological confirmation of Mycobacterium tuberculosis infection was undertaken in all cases. Complementary MRI revealed diffuse bone marrow signal hypointense or isointense on T1-weighted and hyperintense on T2-weighted and STIR images. MRI was able to provide anatomic details of soft tissue lesions and extensions. MRI illustrated the sinus tract in one patient. Ultrasound imaging allowed diagnostic and therapeutic management of in 3 patients. CONCLUSION Tuberculosis of ischial tuberosity can be a rare cause of gluteal pain. Delay in diagnosis could be due to an indolent natural history, unusual presentation and clinical features. A high index of suspicion especially in endemic areas with complementary imaging and microbiological or histopathological confirmation of Mycobacterium tuberculosis infection is necessary for definitive diagnosis. Targeted treatment under the umbrella of Anti-Tubercular Therapy is crucial in achieving successful clinical outcome.
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Affiliation(s)
- Vijay Kumar Jain
- Professor, Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
- Corresponding author.
| | | | - Nipun Rana
- Consultant, GRIPMER, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Agarwal
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Rajesh Botchu
- Consultant Musculoskeletal Radiologist, Royal Orthopedic Hospital, Birmingham, UK
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9
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Asako M, Matsunaga H, Nakahara W, Ikeda M, Mima F, Minami R, Sekiguchi M, Oka K, Wada N, Suzuki K, Yoshizawa K, Sakagami T, Ueda S. Mycobacterial lymphadenitis without granuloma formation in a patient with anti-interferon-gamma antibodies. Int J Hematol 2021; 114:630-635. [PMID: 34328633 PMCID: PMC8322644 DOI: 10.1007/s12185-021-03199-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 11/28/2022]
Abstract
A previously healthy 49-year-old Japanese woman presented with cervical lymph node swelling and tenderness. Lymph node biopsy revealed reactive lymphadenitis without granulomas. No malignant cells were found, and no acid-fast positive bacilli were identified by Ziehl-Neelsen staining. She was treated unsuccessfully with various antibiotics, and it was very challenging to reach a diagnosis. 18F-Fluorodeoxyglucose (18F-FDG) uptake in bones was evaluated using positron emission tomography-computed tomography (PET-CT), and disseminated mycobacterial infection was suspected. The interferon-gamma (IFN-γ) release assays QuantiFERON (QFT) and T-SPOT were used to diagnose tuberculosis infection. On testing, a difference in mitogen response was found between these assays. The response was low for QFT but adequate for T-SPOT, suggesting the presence of anti-IFN-γ antibodies. This difference depended on whether the patient's plasma (including anti-IFN-γ antibodies) was used within the assay system. Mycobacterium abscessus was isolated from lymph node cultures, and plasma anti-IFN-γ antibodies were confirmed. The patient was diagnosed with disseminated M. abscessus infection with underlying adult-onset immunodeficiency caused by anti-IFN-γ antibodies. Granulomas are a pathological hallmark of mycobacterial infection, but may not fully form in immunodeficient patients. Clinicians should be aware of the possibility of mycobacterial infection without granuloma formation due to anti-IFN-γ antibodies.
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Affiliation(s)
- Mizuki Asako
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Hitomi Matsunaga
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Wataru Nakahara
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Mako Ikeda
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Fuka Mima
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Ryota Minami
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan
| | - Masahiro Sekiguchi
- Department of Rheumatology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan
| | - Kazumasa Oka
- Department of Pathology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan
| | - Naoki Wada
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Katsuhiro Suzuki
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Kazutaka Yoshizawa
- Department of Respiratory Medicine and Infectious Disease, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takuro Sakagami
- Department of Respiratory Medicine, Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Shuji Ueda
- Department of Hematology, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan.
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10
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Basnayake O, Mathangasinghe Y, Nihaj A, Pitagampalage R, Jayarajah U, Gunawardena K, Mendis H. Tuberculosis presenting as arthritis of the ankle: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211035574. [PMID: 34377485 PMCID: PMC8320545 DOI: 10.1177/2050313x211035574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis presenting as monoarticular involvement in immunocompetent patients is rare. Here, we report a Sri Lankan patient presenting with ankle swelling due to tuberculosis with no other extrapulmonary or pulmonary involvement. Magnetic resonance imaging showed destruction of articular cartilage of the ankle joint with chronic inflammation of the subtalar joint. The diagnosis was confirmed by synovial tissue culture which was positive for Mycobacterium tuberculosis. The patient recovered uneventfully with anti-tuberculosis treatment. Therefore, a high degree of suspicion is necessary to diagnose extrapulmonary tuberculosis when patients are presenting with atypical monoarthritis.
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Affiliation(s)
| | - Yasith Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ahamed Nihaj
- National Hospital of Sri Lanka, Colombo, Sri Lanka
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Murugan C, Shetty AP, Rajasekaran S. An unusual case of gluteal pain - Case report and review of literature. J Clin Orthop Trauma 2021; 20:101487. [PMID: 34277341 PMCID: PMC8264158 DOI: 10.1016/j.jcot.2021.101487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022] Open
Abstract
Numerous pathologies of the spine, pelvis and hips can present with gluteal pain and pose a challenge to orthopaedic surgeons. We report a unique Case of tuberculous osteomyelitis of the ischium in a young immunocompetent individual presenting as gluteal pain. A high index of suspicion, early diagnosis and prompt management is mandatory to promote early and complete healing and prevent complications.
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Affiliation(s)
| | - Ajoy Prasad Shetty
- Corresponding author. Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
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12
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Feiler S, Fuhrmann RA, Gattenlöhner S, Sommer F. Tuberculosis of the Ankle in a Non-immunocompromised Male: A Case Report and Review of the Literature. J Foot Ankle Surg 2021; 59:1294-1300. [PMID: 32962924 DOI: 10.1053/j.jfas.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/26/2020] [Accepted: 08/09/2020] [Indexed: 02/03/2023]
Abstract
The prevalence and incidence of tuberculosis has declined rapidly in Western Europe during the last century, although a slight increase is being seen due to immigration from countries where tuberculosis is still a common disease. We present a very rare case of primary ankle tuberculosis in a 51-year-old native German male without any risk factors or prior lung manifestation. A delay in diagnosis and treatment when a patient presents with ankle arthritis caused by Mycobacterium tuberculosis should make one aware of the possibility of primary joint tuberculosis, which is extremely unusual and it can mimic various other joint diseases. If the diagnosis is in doubt, early biopsy should be mandatory.
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Affiliation(s)
- Stefan Feiler
- Foot and Ankle Surgeon, Private Practice for Orthopedic Surgery, Schweinfurt, Germany.
| | - Renée A Fuhrmann
- Head of Department, Campus Bad Neustadt, Department of Foot- and Ankle-Surgery, Bad Neustadt, Germany
| | - Stefan Gattenlöhner
- Professor, University Hospital Giessen and Marburg, Department of Pathology, Giessen, Germany
| | - Frank Sommer
- Assistant Professor, University Hospital Giessen and Marburg, Department of Microbiology, Marburg, Germany
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Ozdemir M, Ozdemir HG. Evaluation of patients admitted with musculoskeletal tuberculosis: sixteen years' experience from a single center in Turkey. BMC Musculoskelet Disord 2021; 22:542. [PMID: 34126976 PMCID: PMC8204496 DOI: 10.1186/s12891-021-04426-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background The aim of our study was to describe musculoskeletal system tuberculosis (TB) as a single-center experience. Methods This is a retrospective observational study conducted at a TB Dispensary in the east Mediterranean part of Turkey between 2004 and 2020. The clinical and demographic characteristics including age, gender, involvement location and duration of illness, presenting complaint, local examination findings, treatment outcome were retrieved and analyzed from the case files. Statistical analyses were performed using SPSS Statistics version 17.0 (IBM). The normality of data analysed by using Kolmogorov-Smirnov. The descriptive statistics were reported as mean ± standard deviation, medians, and ranges (min-max). Results Overall, 31 patients (3.2 % of all TB cases) with a mean age of 44.2 ± 16.7 years had musculoskeletal tuberculosis. The mean duration of treatment was 12.9 ± 5.5 months. Of the 31 patients, six (19.4 %) had concomitant pulmonary TB. One of the patients was in the pediatrics age group, and two of them were in the geriatric group. The most affected area was the vertebra. The most common complaint of the patients was back pain and seen in 22 patients (70.9 %). Conclusions The physicians should be suspicious about the diagnosis of musculoskeletal TB disease. If the diagnosis and treatment are delayed, spinal damage and other consequences might be incurable.
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Affiliation(s)
- Mikail Ozdemir
- Osmaniye Tuberculosis Dispensary Public Health Department, Kazım Karabekir Street Musa Şahin Boulevard No:74/513 Center, 80010, Osmaniye, Turkey
| | - H Gulnihal Ozdemir
- Osmaniye State Hospital Pathology Department, Akyar Central Location Hospital Street Center, 80010, Osmaniye, Turkey.
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Extrapulmonary Tuberculosis—An Update on the Diagnosis, Treatment and Drug Resistance. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1020015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pathogenic Mycobacterium tuberculosis complex organisms (MTBC) primarily cause pulmonary tuberculosis (PTB); however, MTBC are also capable of causing disease in extrapulmonary (EP) organs, which pose a significant threat to human health worldwide. Extrapulmonary tuberculosis (EPTB) accounts for about 20–30% of all active TB cases and affects mainly children and adults with compromised immune systems. EPTB can occur through hematogenous, lymphatic, or localized bacillary dissemination from a primary source, such as PTB, and affects the brain, eye, mouth, tongue, lymph nodes of neck, spine, bones, muscles, skin, pleura, pericardium, gastrointestinal, peritoneum, and the genitourinary system as primary and/or disseminated disease. EPTB diagnosis involves clinical, radiological, microbiological, histopathological, biochemical/immunological, and molecular methods. However, only culture and molecular techniques are considered confirmatory to differentiate MTBC from any non-tuberculous mycobacteria (NTM) species. While EPTB due to MTBC responds to first-line anti-TB drugs (ATD), drug susceptibility profiling is an essential criterion for addressing drug-resistant EPTB cases (DR-EPTB). Besides antibiotics, adjuvant therapy with corticosteroids has also been used to treat specific EPTB cases. Occasionally, surgical intervention is recommended, mainly when organ damage is debilitating to the patient. Recent epidemiological studies show a striking increase in DR-EPTB cases ranging from 10–15% across various reports. As a neglected disease, significant developments in rapid and accurate diagnosis and better therapeutic interventions are urgently needed to control the emerging EPTB situation globally. In this review, we discuss the recent advances in the clinical diagnosis, treatment, and drug resistance of EPTB.
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Kaur T, Arora S, Gandhi G. Chronic foot ulcers – Rule out cutaneous tuberculosis! INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2021. [DOI: 10.4103/ijpd.ijpd_140_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Erny D, Taschner U, Nakagawa J, Urbach H, Prinz M, Taschner CA. Freiburg Neuropathology Case Conference : Back Pain and Rapidly Progressing Gait Disorder in a 70-year-old Patient. Clin Neuroradiol 2020; 30:647-653. [PMID: 32845352 PMCID: PMC7471148 DOI: 10.1007/s00062-020-00945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- D Erny
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - U Taschner
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - J Nakagawa
- Department of Neurosurgery, Medical Centre, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
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Ranjan R, Goel L, Sud A, Sinha A, Kumar R. Bilateral Tubercular Dactylitis: Unusual presentation of an usual disease. Indian J Tuberc 2019; 66:346-352. [PMID: 31439178 DOI: 10.1016/j.ijtb.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/08/2017] [Accepted: 05/09/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Bilateral Tubercular Dactylitis (TD) is an unusual presentation of tuberculosis and only handful numbers of cases are reported in the literature. Hence, very little is known about its clinical presentation, statistic, radiological features and its outcome. METHODS We have included seven male and two female patients of mean age 7.2 years, of the proven cases of bilateral TD by histopathological or microbiological or PCR analysis from core biopsy. Radiological features were recorded from plain radiograph. All patients were given Antitubercular drugs according to WHO 2010 recommendation (four drugs for 3-5 months, three drugs for next 3-5 months and finally two drugs for 6-8 months). Debridement was done whenever required. RESULTS Of total 26 lesions, the most common presentation was swelling with or without mild pain. Discharging sinus was present in four lesions. There were six phalanges, 18 metacarpal and two metatarsals. Radiographically, the most common type of lesion was soft tissue swelling followed by lytic lesion. Histopathologically tuberculosis was proven in 10 (55.6%) lesions, bacteria isolated in 5 (27.8%) lesions and PCR was done in 8 lesions and was positive in all. All lesions healed after giving ATT except one which developed psudo-arthrosis and one patient developed coronal plane deformity that was corrected by JESS. CONCLUSION A clinician should always suspect tuberculosis while dealing with a pathology of hand and feet even if it is bilateral. Suspected case can be diagnosed by histopathological, microbiological or PCR analysis and it can be treated by ATT with a good functional outcome.
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Affiliation(s)
- Rahul Ranjan
- Clinical Registrar, Department of Orhopaedics, Lady Hardinge Medical College, New Delhi, India.
| | - Lakshay Goel
- Post-graduate Resident, Department of Orthopardics, Lady Hardinge Medical College, New Delhi, India
| | - Alok Sud
- Professor, Department of Orthopardics, Lady Hardinge Medical College, New Delhi, India
| | - Abhinav Sinha
- Clinical Registrar, Department of Orhopaedics, Lady Hardinge Medical College, New Delhi, India
| | - Ramesh Kumar
- Clinical Registrar, Department of Orhopaedics, Lady Hardinge Medical College, New Delhi, India
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Viswanathan V. An unusual vertical swelling over the back. APOLLO MEDICINE 2019. [DOI: 10.4103/am.am_56_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Stingo FE, Rodriguez-Fontan F, Burger-Van der Walt E, Arce J, Garcia SN, Munafo RM. Isolated Iliac Crest Tuberculosis: A Case Report. JBJS Case Connect 2018; 8:e31. [PMID: 29794486 DOI: 10.2106/jbjs.cc.17.00183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
CASE Following an insidious onset of symptoms, a 29-year-old man who had no risk factors for tuberculosis was diagnosed with tuberculosis of the iliac crest. The red flag in this case was the patient's progressive deterioration despite a variety of antibiotic regimens. Histopathologic demonstration of necrotic granulomatous inflammation and a positive culture led to the diagnosis. A combination of surgery and antitubercular-drug therapy resulted in clinical recovery. CONCLUSION Iliac crest tuberculosis represents <1% of all skeletal tuberculosis cases. Even in the absence of classic symptoms and risk factors, orthopaedic surgeons should maintain a low threshold for tuberculosis in the differential diagnosis.
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Affiliation(s)
- Facundo E Stingo
- CETEA, Buenos Aires, Argentina
- Department of Medicine, MedStar Washington Hospital Center/Georgetown University Hospital, School of Medicine, Washington, DC
- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Francisco Rodriguez-Fontan
- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Sebastian N Garcia
- CETEA, Buenos Aires, Argentina
- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo M Munafo
- CETEA, Buenos Aires, Argentina
- Facultad de Medicina, Universidad de Ciencias Empresariales y Sociales, Buenos Aires, Argentina
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20
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Tuberculosis of knee joint mimicking giant cell tumor - A case report. Indian J Tuberc 2016; 65:260-261. [PMID: 29933871 DOI: 10.1016/j.ijtb.2016.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/30/2016] [Indexed: 11/21/2022]
Abstract
A 50-year-old woman presented with pain, swelling, and reduced range of motion of right knee joint since one year. Radiograph of knee joint revealed eccentric, expansile, geographic lytic lesion on the medial epiphyseal region of tibia mimicking giant cell tumor (GCT). She underwent minimally invasive biopsy, which was positive for acid-fast bacilli and revealed necrotizing chronic granulomatous lesion, diagnostic of tuberculosis (TB). This case emphasizes to consider tuberculosis arthritis as differential diagnosis when a case of destructive giant cell tumor is encountered.
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Abstract
Pediatric skeletal (extraspinal) tuberculosis may mimic pyogenic infections and bone tumors. The aim of this study was to show a multimodality approach to the correct diagnosis and to evaluate the long-term clinical and radiological results of curettage and antituberculosis treatment. Between 2004 and 2012, we treated eight children (five boys, three girls) with histologically proven solitary cystic tuberculosis of the proximal tibia and distal femur. The average age at presentation was 4 years (range, 2-6 years). Except for one case with metadiaphyseal involvement, all lesions were located in the metaphysis and crossed the physis in three. The patients were managed by curettage without bone grafting, followed by antituberculosis therapy. The average follow-up was 4 years (range, 2-7 years). All children achieved complete clinical and radiological healing without any residual lesion or recurrence. In three cases with epiphyseal involvement, the growth plate maintained its function and gradually remodeled within 24 months, without any deformity. No surgical complication was observed. The diagnosis of pediatric skeletal tuberculosis can be made with a good correlation of clinical, radiological, and histological findings. High healing rates can be achieved with surgical debridement and chemotherapy.
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Narang S. Tuberculous Osteomyelitis of the Metatarsals: A Report of Two Cases and Literature Review. JBJS Case Connect 2012; 2:e40. [PMID: 29252538 DOI: 10.2106/jbjs.cc.k.00183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sagar Narang
- 98, Christopher Road, Vrindavan Gardens, Block A2, 10th Floor, Flat 1, Kolkata, 700046, India.
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Rajappa S, Menon PG, Sundaram S. Ewings sarcoma of the hand-a case report. J Hand Microsurg 2012; 2:82-4. [PMID: 22282674 DOI: 10.1007/s12593-010-0016-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 07/12/2010] [Indexed: 11/30/2022] Open
Abstract
Ewings sarcoma of the hand is relatively rare. Ewings sarcoma can present with minimal pain and swelling of the affected digit. The Erythrocyte sedimentation rate and C-reactive protein may be high. Radiologically, Ewings sarcoma can present with a plethora of features from permeative bone destruction to expansile lesions with or without periosteal reaction. Because of these features, this can be confused with Tuberculosis especially in a country like ours where Tuberculosis is endemic. This leads to starting of inappropriate treatment and delay in diagnosis. We report a case of an 18 year old boy who was initially diagnosed as Tuberculous dactylytis of the proximal phalanx of the little finger. He was started on anti-tuberculous treatment and did not respond to it. Subsequent investigation in our centre which also included an open biopsy, confirmed the diagnosis of Ewings sarcoma. He was treated with ray excision, and chemotherapy. This case is being presented for its rarity and also to emphasize the fact that an open biopsy in suspected cases would be appropriate to confirm the diagnosis. This would prevent delay in diagnosis of rare conditions like Ewings sarcoma.
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Donald P. The chemotherapy of osteo-articular tuberculosis with recommendations for treatment of children. J Infect 2011; 62:411-39. [DOI: 10.1016/j.jinf.2011.04.239] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 04/29/2011] [Indexed: 02/07/2023]
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Lemme SD, Kevin Raymond A, Cannon CP, Normand AN, Smith KC, Hughes DPM. Primary tuberculosis of bone mimicking a lytic bone tumor. J Pediatr Hematol Oncol 2007; 29:198-202. [PMID: 17356403 DOI: 10.1097/mph.0b013e31803b959f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Causes of lytic bone lesions in children include benign, malignant, and infectious processes. Here, we present the case of a 3-year-old boy presenting with a lytic bone lesion and surrounding soft tissue mass sent for evaluation of possible malignancy versus osteomyelitis. Biopsy revealed granulomatous osteomyelitis, and subsequent purified protein derivative resulted in 20-mm induration. Lesion cultures eventually identified pan-sensitive Mycobacterium tuberculosis. We emphasize that tuberculosis can cause primary lytic bone lesions in children in the United States, even in the absence of pulmonary symptoms or known exposure, and advise clinicians to include mycobacterial cultures when analyzing biopsies of lytic bone lesions.
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Affiliation(s)
- Scott D Lemme
- University of Texas Health Science Center at Houston Medical School, Department of Pathology, The Children's Cancer Hospital at MD Anderson Cancer Center, Houston, TX 77030, USA
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Jambhekar NA, Kulkarni SP, Madur BP, Agarwal S, Rajan MGR. Application of the polymerase chain reaction on formalin-fixed, paraffin-embedded tissue in the recognition of tuberculous osteomyelitis. ACTA ACUST UNITED AC 2006; 88:1097-101. [PMID: 16877614 DOI: 10.1302/0301-620x.88b8.17625] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A retrospective series of 45 cases of chronic osteomyelitis collected over a period of 14 years was histologically classified into tuberculous osteomyelitis (25) and chronic non-granulomatous osteomyelitis (20). The tuberculous osteomyelitis group was divided into three subgroups: a) typical granulomas (13 cases); b) ill-defined granulomas (seven cases), and c) suspected granulomas (five cases). An in-house polymerase chain reaction amplifying the 245 bp nucleotide sequence, and capable of detecting 10 fg of DNA of Mycobacterium tuberculosis, was used on the DNA extracted from the paraffin blocks. The polymerase chain reaction was positive in 72% of cases (18) of tuberculous osteomyelitis, but when typical cases of tuberculous osteomyelitis with confirmed granulomas were considered (13), this increased to 84.6% (11). The chronic non-granulomatous osteomyelitis group gave positive polymerase chain reaction results in 20% of the cases (4). Our preliminary study on tuberculous osteomyelitis shows that the polymerase chain reaction can be a very useful diagnostic tool, since a good correlation was seen between typical granulomas and polymerase chain reaction with a sensitivity of 84.6% and a specificity of 80%. In addition, our study shows that tuberculous osteomyelitis can be diagnosed in formalin-fixed paraffin-embedded tissues in the absence of typical granulomas.
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Affiliation(s)
- N A Jambhekar
- Department of Pathology, Tata Memorial Hospital, Parel, India.
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Abstract
Acute hematogenous osteomyelitis is most common in children and has the potential to cause life-long musculoskeletal deformities. Most cases are caused by Staphylococcus aureus. Haemophilus influenzae type b (Hib) is now rare in countries that routinely use the Hib vaccine. Although magnetic resonance imaging is the preferred modality in localized disease, scintigraphy is often preferred as the first line of investigation because it helps to clarify the location of infection and exclude the presence of multifocal disease. Where the presentation is typical, there is no underlying disease, there is a low prevalence of community-acquired methicillin-resistant S. aureus (CA-MRSA), and there is a good response to antibacterial therapy, a diagnostic bone aspirate or biopsy is not necessary. The first-line antibacterial choice in most circumstances is a beta-lactamase-resistant penicillin. If CA-MRSA is suspected, the first-line options include clindamycin, the addition of an aminoglycoside or, rarely, vancomycin. In most patients, the total duration of therapy can be substantially shorter than the traditional 6 weeks, and oral therapy can be commenced after a brief course of intravenous antibacterials. We recommend 3 days of intravenous therapy followed by 3 weeks of high-dose oral antibacterials, provided there is no underlying illness, the presentation is typical and acute, and there has been a good response to treatment initially. Any deviation from this requires more intensive confirmation of the diagnosis (with imaging and/or biopsy or aspiration), and prolongation of intravenous therapy and total duration of treatment. Close monitoring and follow-up for at least 2 years are advised to detect complications.
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Affiliation(s)
- Andrew C Steer
- Royal Children's Hospital, Melbourne, Victoria, Australia
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Tumoración de partes blandas de larga evolución. Rev Clin Esp 2003. [DOI: 10.1016/s0014-2565(03)71241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Griffith JF, Kumta SM, Leung PC, Cheng JCY, Chow LTC, Metreweli C. Imaging of musculoskeletal tuberculosis: a new look at an old disease. Clin Orthop Relat Res 2002:32-9. [PMID: 11964629 DOI: 10.1097/00003086-200205000-00006] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
There are certain imaging features that help to differentiate tuberculosis from other bone and joint disorders with a similar presentation. The current authors discuss these distinguishing imaging features particularly with respect to ultrasound, computed tomography, and magnetic resonance imaging. The judicious and appropriate use of these newer imaging modalities coupled with aspiration or biopsy can lead to earlier recognition of musculoskeletal tuberculosis before the onset of debilitating disease.
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Affiliation(s)
- James F Griffith
- Department of Diagnostic Radiology & Organ Imaging, Chinese University, Prince of Wales Hospital, Shatin, Hong Kong
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