Anonymous Mycobacterial Osteomyelitis

Abstract

Discussion Cases of scotochromogenic infection similar to ours have been reported by Weed (7, 8) and Kreiger (3). The diagnosis in these cases was hampered by the fact that the cultures were obtained from open wounds, and contamination with other organisms was present. The four children described in these reports all had osseous lesions with a chronic course. In one case reported by Kreiger, the disease was confused with sarcoidosis and the child received steroid therapy for two months. Cases of fatal disseminated disease in young children with osteomyelitis due to atypical mycobacteria have been reported by Cuttino (1), Van der Hoeven (6) and Yakovac (9). Runyon (5) examined the organisms from these cases and feels they all belong to the Battey group. Osteomyelitis due to human tuberculosis is now a rare disease in this country. This is almost certainly true about osteomyelitis associated with anonymous mycobacteria, but, because of the difficulties in making the diagnosis, it is possible that many cases pass unrecognized. First among these difficulties is the general lack of knowledge among many physicians concerning the existence of this type of infectious bone disease. For many years, socalled “atypical” mycobacteria were considered just saprophytic contaminants. Furthermore, although the disease resembles human tuberculosis, negative and weakly positive tuberculin skin testing and avirulence for guinea pigs may lead the clinician away from a significant mycobacterial infection. This can subsequently result in an erroneous diagnosis such as sarcoidosis or one of the reticuloendothelioses, followed by incorrect and potentially dangerous steroid therapy. The radiologist can play an important role by including this disease in his differntial diagnosis of low-grade chronic osteomyelitis and chronic pulmonary disease in children. He can point out the value of radiographic bone survey in suspected cases even when obvious clinical evidence of osteomyelitis is lacking; and, if necessary, he can stress the importance of closed bone lesion biopsy, use of special mycobacterial cultures, and appropriate animal virulence tests. When a number of mycobacterial skin-testing preparations, standardized as to both sensitivity and specificity, can be made available, these will be of further value in facilitating diagnosis (2).