Diagnosis Of Skeletal Tuberculosis Research Articles

Multifocal skeletal tuberculosis: A case report.

Tuberculosis (TB) of the musculoskeletal system is a rare clinical condition. Multifocal bone involvement is extremely rare and difficult to recognize. Thus, due to the diverse and atypical clinical manifestations of multifocal skeletal TB, the disease is easy to misdiagnose. In the present study, a rare case of atypical disseminated multifocal skeletal TB was reported, which exhibited uncommon findings in radiological images that were more suggestive of a hematological malignancy or metastatic disease. In conclusion, the diagnosis of this condition by conventional diagnostic methods is challenging. The importance of CT-guided needle biopsy and open biopsy in the diagnosis of skeletal TB was emphasized.

Spondylodiscite granulomateuse: surtout la tuberculose mais ne pas omettre le lymphome

Les douleurs lombaires relèvent d'étiologies multiples dont le diagnostic peut être source de grandes difficultés. Le lymphome rachidien primitif est rare et son diagnostic nécessite une biopsie souvent scanoguidée. Un homme de 30 ans, était hospitalisé pour lombalgies inflammatoires évoluant dans un contexte d'altération de l'état général avec à l'examen des douleurs à la palpation des apophyses épineux L2L3, sans syndrome tumoral périphérique. Le bilan biologique montrait un syndrome inflammatoire. Le bilan morphologique était en faveur d'une spondylodiscite. La première biopsie montrait une ostéite granulomateuse. L'aggravation clinique et radiologique sous anti bacillaire a mené à reconsidérer le diagnostic et la deuxième biopsie confirme le diagnostic du lymphome. Le diagnostic de tuberculose osseuse en particulier vertébrale nécessite une confirmation bactériologique et ou histologique pour ne pas méconnaître un lymphome osseux primitif.

A Rare Case of Tuberculosis with Sacrococcygeal Involvement Miming a Neoplasm.

Infection of the lumbosacral junction by tuberculosis is quite rare and occurs in only 1 to 2% of all cases of spinal tuberculosis; moreover, isolated sacrococcygeal or coccygeal tuberculosis is much rarer. Failure to identify and treat these areas of involvement at an early stage may lead to serious complications such as vertebral collapse, spinal compression, and spinal deformity. In the present paper, we report an uncommon case of spinal tuberculosis with sacrococcygeal location revealed by a chronic low back pain that was successfully managed. Computed tomography scan and magnetic resonance imaging of the pelvis revealed a lytic lesion affecting both of sacrum and coccyx causing osseous destruction and suggesting a malignant process. A surgical biopsy was performed to establish the tissue diagnosis. Histopathological report confirmed the diagnosis of skeletal tuberculosis. The patient was treated with antibacillary chemotherapy for a period of 9 months. The follow-up period was of 36 months. There was a full recovery and the patient was asymptomatic.

Multifocal skeletal tuberculosis presenting as paraplegia: A case report

Tuberculosis of the musculoskeletal system is not a common clinical condition; however, multifocal bone involvement is even rarer and difficult to recognize. In this paper, we presented a patient who developed paraplegia 15 days before his hospital admission. He was operated by neurosurgeons due to spinal mass, but postoperative examination revealed vertebral and multifocal skeletal tuberculosis. It is difficult to diagnose this condition by conventional imaging methods. The importance of positron emission tomography (PET) in the diagnosis of skeletal tuberculosis was emphasized. The importance of rehabilitation program in restoring functionality was overviewed in the light of current literature. Vertebral and osteoarticular tuberculosis should be considered in patients with vertebral and thoracic mass presenting with neurological deficits.

Role of fine‐needle aspiration cytology in tuberculosis of bone

This study was designed to evaluate the role of fine-needle aspiration cytology (FNAC) in diagnosis of skeletal tuberculosis (TB). In this retrospective study, 20 cases were retrieved over a 10-year period in which a cytologic diagnosis of osseous TB was rendered. The aspirations were performed with a 22-gauge needle attached on a 20-ml syringe after taking into consideration the radiological findings. The cytologic findings were subdivided into the following categories--epithelioid cell granulomas with necrosis, epithelioid cell granulomas without necrosis, and necrosis only. These cases were either with or without AFB positivity. The smears showed epithelioid cell granulomas in 23 cases (85.2%), multinucleate and Langhans' giant cells in 15 cases (55.6%), and inflammatory cells were noted in the background in 15 cases (55.6%). AFB was positive in six cases (22.7%). FNA provides a simple and safe outpatient procedure for the diagnosis of osseous TB and obviates the need of an open biopsy.

２０年間の骨関節結核の動向

We investigated 24 patients with skeletal tuberculosis in the past 20 years. The age range was from 24 to 86 years (average: 57.2 years). Half of the patients (12 cases) were tuberculous spondylitis. Of nine cases excluding the tuberculous spondylitis cases, three were tenosynovitis and two were psoitis. There was no tuberculous arthritis of the hip and knee joint. Tuberculin reaction was considered to be useful for screening inspection in the diagnosis of skeletal tuberculosis because it was positive in 70% of these patients. If swelling without heat or redness that does not react to antibiotics is seen, tuberculosis should be suspected.

Tuberculosis of the Long Bone in Children

From 1985 to 1994, there were 24 cases of long bone solitary tuberculosis. They were 18 boys and 6 girls with an average age of 18 months. All of the patients were treated by open biopsy and curettage and antituberculosis therapy (isoniazid and rifampin) for 6 months. Two patients had incomplete administration of the drug therapy. The lesions were in the metaphysis. Epiphyseal involvement was not significant. The tuberculin skin test was negative in 3 children and the culture was negative in 17 cases. After 2 years and 8 months' followup, there was radiographic evidence of good bone remodeling. Although there uncommonly is not a delay in diagnosis of skeletal tuberculosis despite prolonged symptoms, diagnostic biopsy with curettage of the lesion is indicated for isolated lesions, especially when the diagnosis is in doubt. It is significant that surgical debridement can shorten the duration of antituberculosis therapy and lead to improved results.

Rib lesions in chronic pulmonary tuberculosis.

The diagnosis of skeletal tuberculosis in human remains has traditionally been based upon the detection of secondary skeletal lesions which result from hemotogenous dissemination of tubercle bacilli (e.g., Pott's disease). Since such lesions develop in less than 7% of cases of human tuberculosis, the paleodemography and paleoepidemiology of this disease have been difficult to assess from skeletal remains. This study presents a new diagnostic approach to tuberculosis, focusing on the skeletal manifestations of chronic pulmonary disease (which comprises approximately 90% of human-form tuberculosis). Four hundred forty-five skeletal remains from persons dying of tuberculosis during the first half of the 20th century were examined. A total of 70/445 (16%) exhibited skeletal lesions in one or more locations as a response to infection. Of these 70, 39 (56%) were found to display a specific set of lesions restricted to the internal aspect of the ribs. These lesions take one of two forms: (1) diffuse periostitis or (2) localized abscess, and appear to correspond to areas of chronic pulmonary infection. The diffuse type of rib lesion is more commonly observed than the localized type. In our observations (and according to the natural history of tuberculosis) the occurrence of chronic pulmonary tuberculosis is usually mutually exclusive with hematogenous dissemination to secondary bone locations. Thus, the detection of rib lesions in cases of chronic pulmonary disease increases the absolute sample size of skeletal tuberculosis by a factor of two in this study.