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Jiang D, Wang X, Dlixiat A, Ma L, Xu Z, Sun G, Jia R, Wu Y, Zhang Y. Comparison of two surgical interventions for advanced stages pubis and pubic symphysis tuberculosis in adults: A retrospective study of 33 cases. Injury 2023; 54:111155. [PMID: 37919114 DOI: 10.1016/j.injury.2023.111155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To compare the clinical efficacy of two surgical interventions in treating advanced stages TB of the pubis and pubic symphysis. METHODS Between June 2010 and January 2020, 33 cases of the advanced pubis and pubic symphysis TB were treated with a one-stage debridement procedure (debridement only group, n = 15) or a one-stage debridement with bone grafting and plate fixation procedure (debridement + plating group, n = 18). The visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), operation time, intraoperative blood loss, complications, time of bone graft fusion, and improvement in the mental component summary (MCS) and physical component summary (PCS) of Short Form-36 (SF-36) were compared and analyzed. RESULTS All patients were followed for 24.9 (SD 1.6) months. All patients were completely cured of the pubis and pubic symphysis TB with no recurrence. There were no significant differences (P >0.05) between the two groups in terms of age, follow-up period and intraoperative blood loss. The post-operative VAS scores, ESR and CRP levels, PCS and MCS scores of two groups significantly improved compared to pre-therapy. The mean operation time in debridement + plating group was 140.9 (43.2) min, which was significantly longer than in debridement only group [94.9(21.8) min, P < 0.01]. The final follow-up (FFU) indices of the VAS score in debridement only group were higher than those in debridement + plating group [1.9 (0.8) vs 1.3 (0.5), P=0.012]. A satisfactory average bony fusion time of 12.2 (3.3) months was achieved in debridement + plating group . CONCLUSIONS A one-stage debridement, bone grafting, and reconstruction plate fixation procedure achieved reconstruction of the integrity and stability of the pelvic ring, pain relief, and rapid cure of bone TB. This procedure is a safe and effective treatment option for advanced pubis and pubic symphysis TB.
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Affiliation(s)
- Dingyu Jiang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Xiyang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China.
| | - Abulizi Dlixiat
- Department of Orthopedics, The Eighth Affiliated Hospital of Xinjiang Medical University, No.106 Yan 'an Road, Tianshan District, Urumqi city, Xinjiang Uygur Autonomous Region 830049, China
| | - Liang Ma
- Department of Orthopedics, The Eighth Affiliated Hospital of Xinjiang Medical University, No.106 Yan 'an Road, Tianshan District, Urumqi city, Xinjiang Uygur Autonomous Region 830049, China
| | - Zhenchao Xu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Guannan Sun
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Runze Jia
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Yunqi Wu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Yilu Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
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Kumar R, Kumar N, Bharti A, Kushwaha SS, Kumar V, Choudhary MC. Pubic Symphysis Tuberculosis Recurrence - A Rare Case Report and Literature Review. J Orthop Case Rep 2023; 13:163-167. [PMID: 37885625 PMCID: PMC10599378 DOI: 10.13107/jocr.2023.v13.i10.3976] [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: 07/27/2023] [Revised: 08/03/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Tuberculosis (TB) of pubic symphysis is an extremely uncommon condition accounting <1% of all musculoskeletal TB. Further recurrence of TB of symphysis pubis is a rare clinical scenario requiring a high level of suspicion for diagnosing the condition. Recurrence of tuberculosis can occur either be due to relapse of the original infection or reinfection due to exogenous Mycobacterium tuberculosis strain. There have only been nine case reports on TB of the pubic symphysis in the last three decades and only 40 patients were identified in English language medical literature so to the best of our knowledge this is the first case report on the recurrence of TB of pubic symphysis. Case Report A 26-year-old female patient presented with pain over symphyseal area for 2 months. Laboratory and radiological investigations were suggestive of TB of symphysis pubis. She was started on oral, category I anti-tubercular therapy (ATT) from DOTS center. Patient on improvement in symptoms discontinued taking ATT after 6 months. About 7 months after stopping ATT, she again presented with pain over symphyseal area and difficulty in walking. Laboratory, radiological investigation, and biopsy were obtained to rule out multidrug-resistant (MDR) TB. The patient improved on 12 months' oral daily ATT regime (HRZES2+HRZE4+HRE6). She was followed up for another 1 year with clinical examination and laboratory investigation after stopping ATT. At present, she is asymptomatic with no signs of recurrence after 1 year of completion of treatment. Conclusion ATT intake should be continued for 12 months for musculoskeletal TB for preventing recurrence. The biopsy needs to be taken from the affected region in recurrence TB to rule out MDR.
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Affiliation(s)
- Rajnand Kumar
- Department of Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Nitish Kumar
- Department of Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Ajay Bharti
- Department of Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Sudhir Shyam Kushwaha
- Department of Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Vivek Kumar
- Department of Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Milind Chandra Choudhary
- Department of Orthopedics, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
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Singh R, Seth I, Aiyappan RK, Singh S, Seth A, Tawde A, Yadav CM, Jain H. Report of a Rare Case of Pubic Symphysis Tuberculosis in an Eight-Year-Old Child: An Unusual Presentation of the Disease. Cureus 2023; 15:e36149. [PMID: 37065338 PMCID: PMC10101693 DOI: 10.7759/cureus.36149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
Tuberculosis is a well-known and ancient disease with a wide range of clinical presentations. Although tuberculosis is a well-known infectious disease, involvement of the symphysis pubis is rare, with only a few documented cases in the medical literature. Distinguishing it from other more common conditions, such as osteomyelitis of the pubic symphysis and osteitis pubis, is essential to avoid delay in diagnosis and to minimize morbidity, mortality, and complications. We present a rare case of tuberculosis of the symphysis pubis in an eight-year-old female from India who was initially misdiagnosed with osteomyelitis. Following the correct diagnosis and commencement of anti-tuberculosis chemotherapy, the patient demonstrated improvement in symptoms and hematological parameters at the three-month follow-up. This case emphasizes the importance of considering tuberculosis as a differential diagnosis in cases of symphysis pubis involvement, especially in areas with a high incidence of tuberculosis. Early diagnosis and appropriate treatment can prevent further complications and improve clinical outcomes.
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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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Jha AK, Jalan D, Beniwal RK. Tubercular Osteomyelitis of Pubis with Labial Abscess: A Rare Presentation of a Common Disease. J Orthop Case Rep 2021; 11:22-25. [PMID: 35415143 PMCID: PMC8930370 DOI: 10.13107/jocr.2021.v11.i12.2550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Skeletal tuberculosis (TB) accounts for 10-15% of all cases of extra-pulmonary TB. The involvement of pubis is extremely rare with only 40 cases of pubic bone TB reported in the medical literature. The presentation of the disease with labial abscess is much rarer with only one case reported till now. Case Report A 23-year-old female presented with symptoms of pain and swelling in the right groin. The patient was evaluated with hematological and radiological investigations and the diagnosis of Tubercular osteomyelitis of pubis with labial abscess was confirmed using AFB staining and culture of the aspirate. The patient was subsequently managed with Anti-tubercular chemotherapy for 18 months and the lesion healed with excellent functional outcome. Conclusion Tubercular Osteomyelitis of the pubis is a rare disease with varied clinical presentation. Timely diagnosis and anti-tubercular chemotherapy usually result in complete recovery.
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Affiliation(s)
- Amit Kumar Jha
- Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Divesh Jalan
- Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India,Address of Correspondence: Dr. Divesh Jalan, Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029. India. E-mail:
| | - R K Beniwal
- Department of Orthopaedics, Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Upadhyaya GK, Kumar A, Iyengar KP, Agarwal A, Jain VK. Current concepts in the diagnosis and management of tuberculosis of the elbow joint. J Clin Orthop Trauma 2021; 19:200-208. [PMID: 34150492 PMCID: PMC8185235 DOI: 10.1016/j.jcot.2021.05.014] [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: 01/03/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022] Open
Abstract
Elbow is an uncommon joint to be affected by Mycobacterium tuberculosis infection. It is involved in approximately 1-5% of all cases with musculoskeletal tuberculosis (TB). Early diagnosis of TB of the elbow joint can be easily missed due to an indolent natural history, delay in presentation, and varied clinical features. Delay in diagnosis can lead to irreversible osteoarticular destruction and loss of joint function. Careful clinical assessment, adequate imaging, microbiological, and/or histopathological confirmation of Mycobacterium tuberculosis infection is essential for early diagnosis of TB of the elbow joint. Judicious and early administration of anti-tubercular therapy can lead to preservation of the joint and a satisfactory functional outcome. Surgical intervention may be needed in later stages of the disease to achieve control of the infection, correction of deformity, instability, and restoration of function.
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Affiliation(s)
- Gaurav Kumar Upadhyaya
- Department of Orthopaedics, All India Institute of Medical Sciences, Raebareli, UP, India
| | - Amit Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Raebareli, UP, India,All India Institute of Medical Sciences, Raebareli, UP, India
| | | | - Anil Agarwal
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India,Corresponding author. Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Science, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India.
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Gautam D, Jain VK, Iyengar KP, Vaishya R, Malhotra R. Total hip arthroplasty in tubercular arthritis of the hip - Surgical challenges and choice of implants. J Clin Orthop Trauma 2021; 17:214-217. [PMID: 33868917 PMCID: PMC8047221 DOI: 10.1016/j.jcot.2021.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022] Open
Abstract
Osteoarticular tuberculosis of the hip joint can be a debilitating disease that can result in severe cartilage degeneration, destruction, and eventual painful arthritis of the hip. Usually, a secondary affliction to a primary lung disease, Tuberculosis (TB) of the hip can be difficult to diagnose due to its indolent natural history and deep-seated nature of the hip joint itself. Untreated, ultimately TB hip leads to disabling arthritis of the hip with limitation of activities of daily living, livelihood, and socio-economic consequences. Historic surgical options such as arthrodesis and excision arthroplasty of TB hip have limitations and several disadvantages. Total hip arthroplasty (THA) is a viable option to restore mobility and relieve pain in patients with severe post-tuberculous arthritis but has been controversial in the past due to the concerns of disease reactivation. We evaluate the current role of THA in TB of the hip, its various applications in different presenting scenarios with a guide to surgical tips and tricks for managing this challenging condition.
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Affiliation(s)
- Deepak Gautam
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Vijay K. Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India,Corresponding author.
| | | | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
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Attarde D, Patil A, Sancheti P, Shyam A. Pubic Ramus Tuberculosis Masquerading as Pseudomonas Infection! JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2020. [DOI: 10.4103/jotr.jotr_55_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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Shende P, Gandhewar M, Gaikwad P, Nanaware S, Risbud Joshi P. Labial swelling: a rare presentation of pubic bone tuberculosis. Trop Doct 2016; 47:176-178. [PMID: 27630094 DOI: 10.1177/0049475516666246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tuberculosis (TB), being a global health problem, represents variedly. Its presentation as a labial swelling secondary to pubic bone TB has been reported rarely in literature. We report a case of pubic bone TB presenting as a labial swelling in a woman of reproductive age. Early diagnosis with fine needle aspiration cytology, acid-fast bacillus (AFB) staining, AFB culture and magnetic resonance imaging with early initiation of treatment resulted in a favourable outcome.
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Affiliation(s)
- Prajakta Shende
- Department of Obstetrics and Gynecology, E.S.I.P.G.I.M.S.R. and Model Hospital Andheri, Mumbai, India
| | - Manisha Gandhewar
- Department of Obstetrics and Gynecology, E.S.I.P.G.I.M.S.R. and Model Hospital Andheri, Mumbai, India
| | - Pradip Gaikwad
- Department of Obstetrics and Gynecology, E.S.I.P.G.I.M.S.R. and Model Hospital Andheri, Mumbai, India
| | - Sandip Nanaware
- Department of Obstetrics and Gynecology, E.S.I.P.G.I.M.S.R. and Model Hospital Andheri, Mumbai, India
| | - Prachi Risbud Joshi
- Department of Obstetrics and Gynecology, E.S.I.P.G.I.M.S.R. and Model Hospital Andheri, Mumbai, India
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Koné S, Gbané-Koné M, Bana A, Touré SA, Kouassi AN, Koffi AG, Eti E, Kouakou NM. [Unusual multifocal osteoarthritis tuberculosis in an immunocompetent patient]. Pan Afr Med J 2015; 20:212. [PMID: 26113943 PMCID: PMC4470444 DOI: 10.11604/pamj.2015.20.212.6015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/03/2015] [Indexed: 12/02/2022] Open
Abstract
Les formes multifocales de la tuberculose, surviennent habituellement chez des sujets immunodéprimés. Dans les formes multifocales, certaines localisations osseuses sont rares. Les auteurs rapportent le cas d'une patiente de 58 ans, immunocompétente qui présentait une tuberculose multifocale associant une atteinte pulmonaire et des localisations osseuses et articulaires inhabituelles (l’épaule, la cheville et le pied homolatéral, la branche illio-pubienne). Le diagnostic a été histologique (biopsie ostéo-articulaire) et bactériologique (mise en évidence des BAAR dans les crachats). Le traitement a été médico-chirurgical.
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Affiliation(s)
- Samba Koné
- Service de Traumato-Orthopédie CHU de Cocody, Abidjan, Côte d'Ivoire
| | | | - Abdoulaye Bana
- Service de Traumato-Orthopédie CHU de Cocody, Abidjan, Côte d'Ivoire
| | | | | | - Akué Gérard Koffi
- Service de Traumato-Orthopédie CHU de Cocody, Abidjan, Côte d'Ivoire
| | - Edmond Eti
- Service de Rhumatologie CHU de Cocody, Abidjan, Côte d'Ivoire
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Dapunt U, Mischnik A, Goeppinger S, Lehner B. A persistent case of tuberculosis of the pubic symphysis and pubic bone. BMJ Case Rep 2014; 2014:bcr-2013-203456. [PMID: 24614780 DOI: 10.1136/bcr-2013-203456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A case of a patient suffering from tuberculosis of the pubic symphysis and pubic bone is presented. There were no symptoms other than pain in the right groin area for 12 months. An X-ray of the pelvis showed an osteodestructive lesion of the pubic bone, and an MRI revealed an abscess formation of the pubic symphysis. Tissue samples were collected via CT-guided needle biopsy. Histological evaluation of tissue and analysis by PCR prompted the diagnosis of musculoskeletal tuberculosis. Despite antituberculous chemotherapy according to the current guidelines, the osteodestructive lesion progressed. This case highlights the difficulty of treating bone infections in general. Moreover, Mycobacterium tuberculosis as a rare causative agent of bone infections is discussed.
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Affiliation(s)
- Ulrike Dapunt
- Department of Orthopaedics and Trauma Surgery, Heidelberg University, Heidelberg, Germany
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