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Luo G, Yang J, Zhao Q, Zhu J, Zhang J, Zhao Z. Mycobacterium tuberculosis joint infections: A case series. INFECTIOUS MEDICINE 2024; 3:100107. [PMID: 38872909 PMCID: PMC11170204 DOI: 10.1016/j.imj.2024.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/15/2024] [Accepted: 04/03/2024] [Indexed: 06/15/2024]
Abstract
Tuberculosis is a chronic infectious disease, caused by Mycobacterium tuberculosis, that seriously endangers human health. Skeletal tuberculosis is the most common type of extrapulmonary tuberculosis and tuberculous arthritis is the second most common type of skeletal tuberculosis. We report a case series of patients with tuberculous arthritis, two of whom had no joint disease in the past and presented as monoarthritis. The final patient had a history of rheumatoid arthritis, with polyarthritis that was aggravated during treatment with glucocorticoids and immunosuppressive drugs. This series of cases can contribute to early diagnosis and treatment with appropriate infection control measures.
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Affiliation(s)
- Gui Luo
- Department of Rheumatology and Immunology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jinshui Yang
- Department of Rheumatology and Immunology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Qianqian Zhao
- Department of Rheumatology and Immunology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jian Zhu
- Department of Rheumatology and Immunology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jianglin Zhang
- Department of Rheumatology and Immunology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Zheng Zhao
- Department of Rheumatology and Immunology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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2
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Tuan HX, Huyen NT, Hung ND, Anh NTH, Duc NM. Imaging features of shoulder tuberculosis with rice bodies formation: A case report. Radiol Case Rep 2024; 19:1608-1613. [PMID: 38333900 PMCID: PMC10850118 DOI: 10.1016/j.radcr.2024.01.043] [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: 11/28/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
Osteoarticular tuberculosis is less common than pulmonary tuberculosis and is often overlooked in the differential diagnosis of people with joint disease. In this article, we present a case of a 71-year-old female patient admitted to the hospital because of pain and limited movement of her right shoulder for a year. The patient had diabetes for 10 years, and no history of tuberculosis or previous history of tuberculosis exposure. Blood test results showed inflammatory condition and positive IGRA test. X-ray, ultrasound and magnetic resonance imaging images revealed osteolytic and sclerotic lesions of the humeral head, diffuse thickening of the synovial membrane, and loose bodies in the joint and bursa. The clinical diagnosis was tuberculous inflammatory osteoarthritis of the right shoulder. The patient underwent arthroscopy surgery to remove loose bodies and the inflamed portion of the synovium and send them to the pathology department. Histopathological examination of the loose bodies and synovial membrane revealed features suggestive of tuberculosis of the shoulder joint. Afterward, the patient was treated with antituberculosis drugs according to the guideline and rehabilitation exercises. After 3 months of treatment, the clinical symptoms were reduced, the pain rating was decreased and the range of motion was increased.
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Affiliation(s)
- Ho Xuan Tuan
- Department of Radiology, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Nguyen-Thi Huyen
- Department of Radiology, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
- Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
| | - Nguyen-Thi Hai Anh
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam
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Compton T, Ferguson NA, Certain L, Nixon D. Extrapulmonary, Chronic Septic Arthritis From Mycobacterium tuberculosis in the Ankle and Subtalar Joints. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00011. [PMID: 38466986 PMCID: PMC10927327 DOI: 10.5435/jaaosglobal-d-23-00273] [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: 11/17/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
In the United States, rates of Mycobacterium tuberculosis infection have been declining for decades. Osteoarticular tuberculosis of the ankle is rarely observed. We present the case of a 65-year-old man who immigrated to the United States from India 24 years before the onset of symptoms. The patient initially reported atraumatic swelling and pain of the left ankle and foot and was treated for venous insufficiency. Later, the patient was referred to a nonsurgical orthopaedic clinic for additional workup and was found to have elevated inflammatory markers. MRI showed septic arthritis and osteomyelitis of the talus, distal tibia, and calcaneus. Joint aspiration revealed elevated white blood cell counts with predominately PMNs. The patient was then referred to an orthopaedic foot and ankle surgeon and underwent extensive irrigation and débridement. The patient was discharged on empiric antibiotics. Culture results from the original joint aspirate returned 14 days after surgery as positive for acid-fast bacillus, later identified as M tuberculosis by sequencing. Empiric antibiotics were discontinued, and the patient was started on appropriate antituberculotic therapy. This case report illustrates the challenge in the diagnosis of skeletal tuberculosis and the importance of including this condition on the differential for patients with atypical foot and ankle presentations.
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Affiliation(s)
- Tyson Compton
- From the Department of Orthopedics, University of Utah, Salt Lake City, UT (Mr. Compton, Dr. Certain, Dr. Nixon); Department of Anatomic Pathology, University of Utah, Salt Lake City, UT (Dr. Ferguson); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (Dr. Certain)
| | - Nicholas Andrew Ferguson
- From the Department of Orthopedics, University of Utah, Salt Lake City, UT (Mr. Compton, Dr. Certain, Dr. Nixon); Department of Anatomic Pathology, University of Utah, Salt Lake City, UT (Dr. Ferguson); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (Dr. Certain)
| | - Laura Certain
- From the Department of Orthopedics, University of Utah, Salt Lake City, UT (Mr. Compton, Dr. Certain, Dr. Nixon); Department of Anatomic Pathology, University of Utah, Salt Lake City, UT (Dr. Ferguson); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (Dr. Certain)
| | - Devon Nixon
- From the Department of Orthopedics, University of Utah, Salt Lake City, UT (Mr. Compton, Dr. Certain, Dr. Nixon); Department of Anatomic Pathology, University of Utah, Salt Lake City, UT (Dr. Ferguson); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (Dr. Certain)
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4
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Katwal S, Ghimire A, Bohra R. Chronic multifocal tubercular osteomyelitis in a young Nepalese boy: A rare case presentation. Radiol Case Rep 2024; 19:1190-1194. [PMID: 38259717 PMCID: PMC10801132 DOI: 10.1016/j.radcr.2023.12.016] [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: 09/04/2023] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 01/24/2024] Open
Abstract
This study presents a rare case of chronic multifocal tubercular osteomyelitis in a 13-year-old boy from Nepal, a high-burden country for tuberculosis (TB). He presented with chronic pain in the lower extremities and had no pre-existing comorbidities. The patient's clinical presentation, diagnostic process, and treatment plan are described. Multifocal skeletal TB, though infrequent, poses diagnostic challenges due to its variable manifestations. This case emphasizes the importance of considering TB in differential diagnoses, especially in endemic regions, necessitating a high index of suspicion. Early detection and treatment align with WHO's "End TB" strategy and Nepal's TB management guidelines, promoting improved outcomes in high-risk populations.
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Affiliation(s)
- Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura Nepal
| | | | - Rhea Bohra
- Patan Academy of Health Sciences, Lalitpur, Nepal
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5
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Pattamapaspong N, Kanthawang T, Bouaziz MC, Ladeb MF, Hammami N, Peh WCG. Imaging of musculoskeletal tuberculosis. Br J Radiol 2024; 97:1-12. [PMID: 38263840 PMCID: PMC11027299 DOI: 10.1093/bjr/tqad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/23/2023] [Accepted: 10/06/2023] [Indexed: 01/25/2024] Open
Abstract
Extra-pulmonary tuberculosis (TB) of the musculoskeletal system usually manifests with non-specific clinical features, mimicking a variety of diseases. Diagnosis and treatment of spinal and extra-spinal musculoskeletal TB are often challenging. Imaging has an important role in detecting this disease, aiding diagnosis, identifying complications, and monitoring disease progression. Radiographs and magnetic resonance imaging are the key imaging modalities utilized. Radiologists should aim to be familiar with the spectrum of imaging features of TB affecting spinal and extra-spinal locations in the musculoskeletal system.
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Affiliation(s)
- Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Thanat Kanthawang
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Mouna Chelli Bouaziz
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis-El Manar University, Tunis, Tunisia
| | - Mohamed Fethi Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
- Faculty of Medicine of Tunis, Tunis-El Manar University, Tunis, Tunisia
| | - Nadia Hammami
- Department of Neuroradiology, National Institute of Neurology Mongi Ben Hamida, Tunis, Tunisia
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore
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Abid W, Ladeb MF, Chidambaranathan N, Peh WCG, Vanhoenacker FM. Imaging of musculoskeletal tuberculosis. Skeletal Radiol 2024:10.1007/s00256-023-04556-5. [PMID: 38231262 DOI: 10.1007/s00256-023-04556-5] [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: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Tuberculosis (TB) represents a major public health problem worldwide. Any tissue may be infected. Involvement of the musculoskeletal (MSK) system account for 1-3% of all tuberculous infections. MSK TB may manifest as tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue infections. Although TB spondylitis may present with distinctive imaging features compared to pyogenic infections of the spine, the imaging semiology of extra-spinal TB infections is mostly nonspecific and may mimic other lesions. TB infections should therefore always be considered in the differential diagnosis, particularly in immunocompromised patients. The aim of this article is to review the imaging features of spinal and extra-spinal MSK TB. Magnetic resonance imaging is considered the modality of choice to make the diagnosis and to evaluate the extent of the disease.
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Affiliation(s)
- Wiem Abid
- Department of Radiology, (Vrije Universiteit Brussel), University Hospital Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Mohamed F Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
| | - Natesan Chidambaranathan
- Department of Radiology & Imaging Sciences, Apollo Hospitals, 21, Greams Lane, Chennai, 600 006, India
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Republic of Singapore
| | - Filip M Vanhoenacker
- General Hospital Sint-Maarten Mechelen, Liersesteenweg 435, 2800, Mechelen, Belgium.
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat, 655, B-2650, Edegem, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Ghent and KU Leuven, Belgium.
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Spekker O, Kiss P. A, Kis L, Király K, Varga S, Marcsik A, Schütz O, Török T, Hunt DR, Tihanyi B. White plague among the "forgotten people" from the Barbaricum of the Carpathian Basin-Cases with tuberculosis from the Sarmatian-period (3rd-4th centuries CE) archaeological site of Hódmezővásárhely-Kenyere-ér, Bereczki-tanya (Hungary). PLoS One 2024; 19:e0294762. [PMID: 38198442 PMCID: PMC10781108 DOI: 10.1371/journal.pone.0294762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/07/2023] [Indexed: 01/12/2024] Open
Abstract
Tuberculosis (TB) is a bacterial infection that is well-known in the palaeopathological record because it can affect the skeleton and consequently leaves readily identifiable macroscopic alterations. Palaeopathological case studies provide invaluable information about the spatio-temporal distribution of TB in the past. This is true for those archaeological periods and geographical regions from when and where no or very few TB cases have been published until now-as in the Sarmatian period (1st-5th centuries CE) in the Barbaricum of the Carpathian Basin. The aim of our paper is to discuss five newly discovered TB cases (HK199, HK201, HK225, HK253, and HK309) from the Sarmatian-period archaeological site of Hódmezővásárhely-Kenyere-ér, Bereczki-tanya (Csongrád-Csanád county, Hungary). Detailed macromorphological evaluation of the skeletons focused on the detection of bony changes likely associated with different forms of TB. In all five cases, the presence of endocranial alterations (especially TB-specific granular impressions) suggests that these individuals suffered from TB meningitis. Furthermore, the skeletal lesions observed in the spine and both hip joints of HK225 indicate that this juvenile also had multifocal osteoarticular TB. Thanks to the discovery of HK199, HK201, HK225, HK253, and HK309, the number of TB cases known from the Sarmatian-period Carpathian Basin doubled, implying that the disease was likely more frequent in the Barbaricum than previously thought. Without the application of granular impressions, the diagnosis of TB could not have been established in these five cases. Thus, the identification of TB in these individuals highlights the importance of diagnostics development, especially the refinement of diagnostic criteria. Based on the above, the systematic macromorphological (re-)evaluation of osteoarchaeological series from the Sarmatian-period Carpathian Basin would be advantageous to provide a more accurate picture of how TB may have impacted the ancestral human communities of the Barbaricum.
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Affiliation(s)
- Olga Spekker
- Ancient and Modern Human Genomics Competence Centre, University of Szeged, Szeged, Hungary
- Institute of Archaeological Sciences, Eötvös Loránd University, Budapest, Hungary
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - Attila Kiss P.
- Department of Early Hungarian and Migration Period Archaeology, Pázmány Péter Catholic University, Budapest, Hungary
| | - Luca Kis
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- Department of Archaeogenetics, Institute of Hungarian Research, Budapest, Hungary
| | - Kitty Király
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- Department of Archaeology, Móra Ferenc Museum, Szeged, Hungary
| | - Sándor Varga
- Department of Archaeology, Móra Ferenc Museum, Szeged, Hungary
| | - Antónia Marcsik
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - Oszkár Schütz
- Department of Archaeogenetics, Institute of Hungarian Research, Budapest, Hungary
- Department of Genetics, University of Szeged, Szeged, Hungary
| | - Tibor Török
- Ancient and Modern Human Genomics Competence Centre, University of Szeged, Szeged, Hungary
- Department of Archaeogenetics, Institute of Hungarian Research, Budapest, Hungary
- Department of Genetics, University of Szeged, Szeged, Hungary
| | - David R. Hunt
- Virginia Office of the Chief Medical Examiner, Northern District, Manassas, Virginia, United States of America
| | - Balázs Tihanyi
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- Department of Archaeogenetics, Institute of Hungarian Research, Budapest, Hungary
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Libor C, Hajdu T, Szeniczey T, Kovács LO, Kunos L, Mateovics-László O. "Tuberculosis on the spot" - Discussion of a probable sternal tuberculosis from a late medieval cemetery from Hungary. Tuberculosis (Edinb) 2023; 143S:102410. [PMID: 38012916 DOI: 10.1016/j.tube.2023.102410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 11/29/2023]
Abstract
Investigations of non-adult remains are particularly suitable for finding epidemic periods in past populations. This study presents a probable unique example of osseous manifestation of tuberculosis on a child's skeletal remains from medieval Hungary. Between 2009 and 2011 the Field Service for Cultural Heritage excavated the exceptional cemetery of Perkáta - Nyúli-dűlő in Hungary, with around 5000+ graves. The analysed skeleton (SNR 948) was located in the medieval (10-16th century) part of the cemetery. Besides the standard macroscopic pathological observation, we also performed radiographic analysis. The remains of the child (13-14 year-old) showed numerous skeletal lesions: the ribs have proliferative lesions (dense nodules) on the visceral surface of the shaft, lytic lesions with rounded edges occurred on the thoracic and lumbar vertebral bodies, and on the facies auricularis of the left ilium we can see pitting and new bone formation. What makes this pathological case exceptional is the significant change in the manubrium. It shows extensive osteolytic lesions, probably due to tuberculous osteomyelitis, which is a unique phenomenon in an archaeological context. This rare type of extra-spinal tuberculous osteomyelitis appears in less than 1% of cases with skeletal TB, and even less in case of children, according to modern medical literature. Although some cases of slight lesions on the manubrium have been described from an archaeological context, no such cases showing advanced lesions have been published so far. In the future, biomolecular analyses should be conducted as well, in order to confirm the presence of TB in this individual.
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Affiliation(s)
- Csilla Libor
- Hungarian National Museum, Eötvös Loránd University, Budapest, Hungary.
| | - Tamás Hajdu
- Eötvös Loránd University, Budapest, Hungary.
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Mahomed N, Kilborn T, Smit EJ, Chu WCW, Young CYM, Koranteng N, Kasznia-Brown J, Winant AJ, Lee EY, Sodhi KS. Tuberculosis revisted: classic imaging findings in childhood. Pediatr Radiol 2023; 53:1799-1828. [PMID: 37217783 PMCID: PMC10421797 DOI: 10.1007/s00247-023-05648-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 05/24/2023]
Abstract
Tuberculosis (TB) remains one of the major public health threats worldwide, despite improved diagnostic and therapeutic methods. Tuberculosis is one of the main causes of infectious disease in the chest and is associated with substantial morbidity and mortality in paediatric populations, particularly in low- and middle-income countries. Due to the difficulty in obtaining microbiological confirmation of pulmonary TB in children, diagnosis often relies on a combination of clinical and radiological findings. The early diagnosis of central nervous system TB is challenging with presumptive diagnosis heavily reliant on imaging. Brain infection can present as a diffuse exudative basal leptomeningitis or as localised disease (tuberculoma, abscess, cerebritis). Spinal TB may present as radiculomyelitis, spinal tuberculoma or abscess or epidural phlegmon. Musculoskeletal manifestation accounts for 10% of extrapulmonary presentations but is easily overlooked with its insidious clinical course and non-specific imaging findings. Common musculoskeletal manifestations of TB include spondylitis, arthritis and osteomyelitis, while tenosynovitis and bursitis are less common. Abdominal TB presents with a triad of pain, fever and weight loss. Abdominal TB may occur in various forms, as tuberculous lymphadenopathy or peritoneal, gastrointestinal or visceral TB. Chest radiographs should be performed, as approximately 15% to 25% of children with abdominal TB have concomitant pulmonary infection. Urogenital TB is rare in children. This article will review the classic radiological findings in childhood TB in each of the major systems in order of clinical prevalence, namely chest, central nervous system, spine, musculoskeletal, abdomen and genitourinary system.
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Affiliation(s)
- Nasreen Mahomed
- University of Witwatersrand, 7 York Road Parktown, Johannesburg, 2193, South Africa.
| | - Tracy Kilborn
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Elsabe Jacoba Smit
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Winnie Chiu Wing Chu
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Catherine Yee Man Young
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Nonceba Koranteng
- University of Witwatersrand, 7 York Road Parktown, Johannesburg, 2193, South Africa
| | | | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA
| | - Kushaljit Singh Sodhi
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
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Jahanshahi A, Nami S, Hosein Pour Feizi AA, Alihosseini S, Jaberinezhad M, Abdollahi M, Rahimi F, Falahatian M. Muscular and hepatosplenic candidiasis in a patient with acute myeloblastic leukemia: A case report and literature review. Clin Case Rep 2023; 11:e7700. [PMID: 37476594 PMCID: PMC10354359 DOI: 10.1002/ccr3.7700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023] Open
Abstract
Key Clinical Message Muscular and subcutaneous candidiasis is a rare entity in immunocompromised patients, but it should be kept in mind when we see multiple cystic soft tissue masses in addition to target-shaped hepatosplenic lesions in neutropenic patients. US and MRI are useful imaging modalities for the diagnosis and follow-up of these patients. Abstract Soft tissue candidiasis is an opportunistic infection in immunocompromised patients and must always be diagnosed and treated as soon as possible. In this case report, the patient is a 14-year-old boy with acute myeloid leukemia M3-type who presented with numerous soft tissue and hepatosplenic candidal abscesses.
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Affiliation(s)
- Amirreza Jahanshahi
- Medical Radiation Sciences Research GroupTabriz University of Medical SciencesTabrizIran
- Department of RadiologyTabriz University of Medical SciencesTabrizIran
| | - Sanam Nami
- Department of Parasitology and MycologySchool of MedicineTabriz University of Medical SciencesTabrizIran
| | | | - Samin Alihosseini
- Medical Radiation Sciences Research GroupTabriz University of Medical SciencesTabrizIran
- Department of RadiologyTabriz University of Medical SciencesTabrizIran
| | | | - Mirsaeed Abdollahi
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | - Faezeh Rahimi
- Department of RadiologyZanjan University of Medical SciencesZanjanIran
| | - Masih Falahatian
- Medical Radiation Sciences Research GroupTabriz University of Medical SciencesTabrizIran
- Department of RadiologyTabriz University of Medical SciencesTabrizIran
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11
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Nogdallah S, Mustafa MEAE, Khairy AM, Fatooh M, Abd‐Elmaged HMA. Foot and ankle tuberculosis: A case report and review of the literature. Clin Case Rep 2023; 11:e7483. [PMID: 37323263 PMCID: PMC10264735 DOI: 10.1002/ccr3.7483] [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: 01/04/2023] [Revised: 04/12/2023] [Accepted: 05/14/2023] [Indexed: 06/17/2023] Open
Abstract
Key clinical message It is important to consider foot and ankle tuberculosis (TB) as a potential cause of cystic lesion around the ankle, especially in patients with a history of TB. Early diagnosis and treatment with a rifampin-based regimen for a duration of 12 months can lead to good functional and clinical outcomes. Abstract Skeletal TB is an uncommon accounting for 10% of extra-pulmonary TB may present slowly over an extended period of time, making a diagnosis difficult and time-consuming (Microbiology Spectr. 2017;5:5). For the best possible outcome and to reduce the risk of deformity diagnosis must be early (Foot (Edinb). 2018;37:105). For the treatment of drug-susceptible musculoskeletal illness, a rifampin-based regimen lasting 12 months is advised (Clin Infect Dis. 2016;63:e147; J Bone Joint Surg Br. 1993;75:240; Tubercle. 1986;67:243). A 33-year-old female who are working as nurse with diffuse, persistent and low in intensity ankle pain not aggravated relieved by analgesia and swelling over a period of 2 months, static not related to activity. With past medical history of partially treated pulmonary TB 1 year ago. She reported night sweats and low-grade fever during this period, and she denied any history of trauma. The right ankle was globally swollen and tender anteriorly and on the lateral malleolus. The skin over the ankle showed dark discoloration with cautery marks with no discharging sinuses. The range of motion of the right ankle was decreased. The plain x-ray of the right ankle showed three cystic lesion at the distal tibia, one cyst at the lateral malleolus and another one at the calcaneum. Surgical biopsy and expert gene test confirmed the diagnosis of tuberculous osteomyelitis. The patient was planned for surgical curettage of the lesion. After the confirmation of the diagnosis of TB with the biopsy and gene expert test, with consultation of senior chest physician the patient fitted to anti-tuberculous regimen. The patient had good functional and clinical outcome. This case report highlights the importance of considering skeletal TB as a potential cause of musculoskeletal symptoms, especially in patients with a history of TB. Early diagnosis and treatment with a rifampin-based regimen for a duration of 12 months can lead to good functional and clinical outcomes. Further research on the management and prevention of musculoskeletal TB is warranted to improve patient outcomes. The lesson behind this case is that the diagnosis TB osteomyelitis should be on the top of differential diagnosis of multiple cystic lesions around the foot and ankle especially in area where TB is endemic. Early diagnosis and early start of anti-tuberculous therapy can lead to full cure of the patient and in bad situation can minimize the complications.
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12
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Gupta S, Parihar A, Singh S, Agarwal A, Agarwal S. Pediatric Osteoarticular Tuberculosis as a Diagnostic Dilemma and a Review of Literature. Cureus 2022; 14:e23053. [PMID: 35308187 PMCID: PMC8926030 DOI: 10.7759/cureus.23053] [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: 03/10/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Despite tuberculosis being rampant in the Indian subcontinent, most cases of osteoarticular (OA) tuberculosis (TB) are missed until significant bony destruction has occurred. Initial presentation of extra-pulmonary TB mimics many other disease entities while many diseases mimic TB. This may lead to an incorrect diagnosis and sometimes creates a dilemma in reaching the correct diagnosis. The aim of this study was to evaluate a series of pediatric cases of osteoarticular TB, which posed a diagnostic challenge to us. Material and methods Retrospective analysis of case records of pediatric OA-TB patients who had presented to two tertiary level centers of urban India between February 2016 and December 2020 was done. There were a total of 69 patients. Observations There were 37 males and 32 females. The age range was from two to 17 years. Forty-four patients showed evidence of disease within the spine (dorsal region followed by lumbar, followed by the cervical spine), 16 showed disease of the extremities, six had disease of the girdle bones, and three showed disease of the short bones of hands or foot. In our series, patients presented to us between 15 days to six months from the onset of symptoms. From our series, six cases with atypical clinical pictures have been selected for presentation purposes. In all six cases, the initial presentation was not that of OA-TB. However, with a high degree of suspicion, differential diagnosis of TB was kept in mind, and the diagnosis was confirmed microbiologically. Conclusion A high degree of suspicion is required to avoid missing the diagnosis of osteoarticular TB. Non-invasive advanced radiological investigations such as MRI and microbiological analysis of biopsy specimens aid in arriving at the correct diagnosis.
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13
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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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14
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Furman MS, Restrepo R, Kritsaneepaiboon S, Laya BF, Plut D, Lee EY. Updates and Advances: Pediatric Musculoskeletal Infection Imaging Made Easier for Radiologists and Clinicians. Semin Musculoskelet Radiol 2021; 25:167-175. [PMID: 34020476 DOI: 10.1055/s-0041-1723004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Infants and children often present with a wide range of musculoskeletal (MSK) infections in daily clinical practice. This can vary from relatively benign superficial infections such as cellulitis to destructive osseous and articular infections and life-threatening deep soft tissue processes such as necrotizing fasciitis. Imaging evaluation plays an essential role for initial detection and follow-up evaluation of pediatric MSK infections. Therefore, a clear and up-to-date knowledge of imaging manifestations in MSK infections in infants and children is imperative for timely and accurate diagnosis that, in turn, can result in optimal patient management. This article reviews an up-to-date practical imaging techniques, the differences between pediatric and adult MSK infections, the spectrum of pediatric MSK infections, and mimics of pediatric MSK infections encountered in daily clinical practice by radiologists and clinicians.
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Affiliation(s)
- Michael S Furman
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island
| | - Ricardo Restrepo
- Interventional Pediatric Radiology and Body Imaging, Division of Radiology, Department of Radiology, Nicklaus Children's Hospital, Miami, Florida
| | - Supika Kritsaneepaiboon
- Section of Pediatric Imaging, Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Bernard F Laya
- Institute of Radiology, Section of Pediatric Radiology, St. Luke's Medical Center-Quezon City, St. Luke's Medical Center College of Medicine - William H. Quasha Memorial, Quezon City, Philippines
| | - Domen Plut
- Division of Pediatric Radiology, Clinical Radiology Institute, University Medical Centre and Faculty of Medicine Ljubljana, Ljubljana, Slovenia
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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15
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Abstract
AbstractMusculoskeletal infection can be an urgent or emergent clinical issue. Accurate imaging diagnosis is an essential part of the treatment algorithm. This review addresses advantages of available imaging modalities and radiologic appearance of the various manifestations of infection. Controversies are addressed, including the use of the term “osteitis.” Finally, the differential diagnosis of infection is reviewed, such as inflammatory arthropathies and tumors that can simulate infection on imaging exams.
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16
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Natali D, Cloatre G, Brosset C, Verdalle P, Fauvy A, Massart JP, Vo Van Q, Gerard N, Dobler CC, Hovette P. What pulmonologists need to know about extrapulmonary tuberculosis. Breathe (Sheff) 2021; 16:200216. [PMID: 33664835 PMCID: PMC7910020 DOI: 10.1183/20734735.0216-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Extrapulmonary tuberculosis (EPT) can affect all organs. Its diagnosis is often challenging, especially when the lung is not involved. Some EPT locations, such as when the central nervous system is involved, are a medical emergency, and some have implications for treatment options and length. This review describes clinical features of EPT, diagnostic tests and treatment regimens. Extrapulmonary tuberculosis can affect any organ, can be potentially life threatening or disabling, poses diagnostic difficulties and may change the type and length of treatment. Looking for concomitant pulmonary tuberculosis is essential.https://bit.ly/2YEaRVb
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Affiliation(s)
| | | | | | - Pierre Verdalle
- Ear-Nose-Throat Diseases, Hanoi French Hospital, Hanoi, Vietnam
| | - Alain Fauvy
- Orthopedic Surgery, Hanoi French Hospital, Hanoi, Vietnam
| | | | - Quy Vo Van
- Urology, Hanoi French Hospital, Hanoi, Vietnam
| | - Nelly Gerard
- Dermatology, Hanoi French Hospital, Hanoi, Vietnam
| | - Claudia C Dobler
- Dept of Respiratory Medicine, Liverpool Hospital, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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17
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Suh JY, Park SY, Koh SH, Lee IJ, Lee K. Unusual, but important, peri- and extra-articular manifestations of rheumatoid arthritis: a pictorial essay. Ultrasonography 2021; 40:602-616. [PMID: 34399048 PMCID: PMC8446489 DOI: 10.14366/usg.20161] [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] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/02/2021] [Indexed: 11/08/2022] Open
Abstract
Ultrasonography is a useful technique to detect soft tissue changes of rheumatoid arthritisnot only synovitis, but also tenosynovitis, bursitis, and enthesitis-even at a subclinical stage. However, radiologists tend to focus on synovitis in daily practice, and unusual peri- or extra-articular manifestations of rheumatoid arthritis are difficult to detect at the initial presentation. This pictorial essay describes a broad spectrum of ultrasonographic findings in tendons, bursae, ligaments, subcutaneous tissues, bones, and nerves to assist in the accurate diagnosis of rheumatoid arthritis.
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Affiliation(s)
- Ji Young Suh
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sun-Young Park
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sung Hye Koh
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - In Jae Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kwanseop Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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18
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He Y, Liu J, Wang Z, Zhou P, Deng X, Yang L, Chen Z, Li Z. Analysis of the early clinical outcomes of arthroscopic debridement in the treatment of shoulder tuberculosis. J Orthop Surg Res 2020; 15:550. [PMID: 33218347 PMCID: PMC7678300 DOI: 10.1186/s13018-020-02086-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Due to atypical clinical symptoms, it is difficult to diagnose joint tuberculosis infection, which often results in misdiagnosis and missed diagnosis. It is easy to cause joint disability. And there are few reports of using arthroscopy to diagnose and treat shoulder tuberculosis. This case series aims to introduce the clinical outcomes of arthroscopic treatment of shoulder tuberculosis. Methods Twenty-nine patients with shoulder tuberculosis from September 2013 to February 2019 were included (10 males, 19 females; age range from 22 to 69; the average age is 37.6 years). All patients underwent arthroscopic lesion debridement, with preoperative and postoperative regular use of isoniazid, rifampicin, pyrazinamide, and streptomycin quadruple anti-tuberculosis drugs. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded before and at the last follow-up. The shoulder function was evaluated according to the visual analogue scoring method (visual analogue scale, VAS) pain score and Constant score. Results Twenty-nine patients were followed up from 12 months to 2 years, and the average follow-up time was 15.7 months. The pathological diagnosis of all patients after surgery was shoulder tuberculosis. No serious complications were found at the last follow-up, and the incision healed well. VAS pain score, Constant score, ESR, and CRP at the last follow-up were significantly improved compared with those before treatment (P < 0.05). Conclusion On the basis of the standard use of anti-tuberculosis drugs before and after surgery, shoulder arthroscopy is used to treat early and mid-term shoulder tuberculosis, which can be diagnosed by direct observation under the arthroscope and postoperative pathological examination. It has the advantages of thorough lesion removal, minimal invasiveness, rapid recovery, and reliable clinical effect.
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Affiliation(s)
- Yanwei He
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Juncai Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Zhi Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Peng Zhou
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Xiangtian Deng
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China.,School of Medicine, Nankai University, Tian Jin, People's Republic of China
| | - Li Yang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China.,Department of Hematology, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Zan Chen
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Lu Zhou, Si Chuan Province, People's Republic of China.
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19
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Guillouzouic A, Andrejak C, Peuchant O, Hery-Arnaud G, Hamdad F, Lanotte P, Gaborit B, Bernard L, Bémer P. Treatment of Bone and Joint Tuberculosis in France: A Multicentre Retrospective Study. J Clin Med 2020; 9:jcm9082529. [PMID: 32764500 PMCID: PMC7464673 DOI: 10.3390/jcm9082529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Nine percent of all cases of tuberculosis are bone and joint tuberculosis (BJTB). BJTB occurs in two main forms: spinal (STB) and extraspinal (ESTB). The aim of this study was to compare STB with ESTB in terms of diagnosis, treatment and outcomes. Methods: We collected demographic, clinical, microbiological, treatment duration and outcome data for patients with BJTB in a retrospective multicentre study over a 17-year period. Results: Of the 116 patients included in the study, 69 (59.5%) had STB and 47 (40.5%) had ESTB. The median age was higher in the ESTB group. There were significantly more foreign-born patients in the STB group. The median time for diagnosis was longer for ESTB (6 months) than STB (4 months) (p = 0.017). Magnetic resonance imaging was highly reliable for the diagnosis. Direct examination and histology allowed the diagnosis to be made in more than 80% of cases. The median treatment duration of 12 months, regardless of the type of BJTB, was longer than recommended. A favourable outcome was achieved in 91.9% of cases. Conclusion: The management of BJTB remains challenging. An earlier diagnosis should be more effective, reducing the total duration of treatment and leading to better tolerance.
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Affiliation(s)
- Aurélie Guillouzouic
- Department of Bacteriology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44095 Nantes, France;
- Correspondence: ; Tel.: +33-(0)2-4008-4188
| | - Claire Andrejak
- Respiratory Department, Amiens University Hospital, 80000 Amiens, France;
| | - Olivia Peuchant
- Department of Bacteriology, Bordeaux University Hospital, 33000 Bordeaux, France;
| | - Geneviève Hery-Arnaud
- Department of Bacteriology, Brest University Hospital, 2 Avenue Foch, 29200 Brest, France;
| | - Farida Hamdad
- Department of Bacteriology, Amiens University Hospital, 80000 Amiens, France;
| | - Philippe Lanotte
- Department of Bacteriology, Tours University Hospital, 2 Allee Gaston Pages, 37081 Tours, France;
| | - Benjamin Gaborit
- Infectious Disease Department, Nantes University Hospital, 1 Place Alexis Ricordeau, 44095 Nantes, France;
| | - Louis Bernard
- Infectious Disease Department, Tours University Hospital, 2 Allee Gaston Pages, 37081 Tours, France;
| | - Pascale Bémer
- Department of Bacteriology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44095 Nantes, France;
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20
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Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings. Radiographics 2020; 39:2023-2037. [PMID: 31697616 DOI: 10.1148/rg.2019190109] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.
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Affiliation(s)
| | - Martin Eduardo Renjifo
- From the Department of Radiology, Fundación Valle del Lili-Universidad Icesi, Carrera 98 #18-49, Cali, Colombia
| | - Francisco José Medina
- From the Department of Radiology, Fundación Valle del Lili-Universidad Icesi, Carrera 98 #18-49, Cali, Colombia
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21
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Nataprawira HM, Ediwan NA, Diana IA, Dwiyana RF, Febrina D. Multifocal Osteomyelitic Tuberculosis at Rare Locations with Metastatic Tuberculosis Abscess. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:503-507. [PMID: 30975973 PMCID: PMC6474155 DOI: 10.12659/ajcr.913615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patient: Female, 9 Final Diagnosis: Multifocal osteomyelitic tuberculosis at rare locations with metastatic tuberculosis abscess Symptoms: Lumps at the left elbow joint • lateral side the left hand • lateral side of the left feet Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Heda Melinda Nataprawira
- Department of Child Health, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Natasha A Ediwan
- Department of Child Health, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Inne Arline Diana
- Department of Dermato-Venerology, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Reiva Farah Dwiyana
- Department of Dermato-Venerology, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Dia Febrina
- Department of Dermato-Venerology, Universitas Padjadjaran - Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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22
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Sogkas G, Holz A, Riechers E, Länger F, von Falck C, Schmidt RE, Witte T. Tuberculous coxitis with trochanteric bursitis manifesting a year after immigration to Germany: a case report. J Med Case Rep 2018; 12:332. [PMID: 30400821 PMCID: PMC6220512 DOI: 10.1186/s13256-018-1867-9] [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: 01/31/2017] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Osteoarticular tuberculosis is rare in Germany. In particular, trochanteric bursitis is an extremely rare manifestation of osteoarticular tuberculosis. We describe a case of tuberculous coxitis with trochanteric bursitis, successfully treated with a fourfold tuberculostatic therapy. Case presentation We report the case of a 43-year-old human immunodeficiency virus-negative Sudanese man with osteoarticular tuberculosis, who was originally admitted with the suspected diagnosis of ankylosing spondylitis. Low grade fever together with the positive result of an interferon-gamma release assay test as well as findings from magnetic resonance imaging provided clues to the diagnosis. A definitive diagnosis could be set after a computed tomography-guided biopsy. Conclusions Apart from a rare involvement pattern of osteoarticular tuberculosis, including trochanteric bursitis, this case highlights the increasing importance of osteoarticular tuberculosis as a differential diagnosis of rheumatic disorders. With the growing migration flows from tuberculosis-endemic African countries, clinicians in central and northern Europe may be more frequently confronted with atypical involvement patterns of osteoarticular tuberculosis.
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Affiliation(s)
- Georgios Sogkas
- Hannover Medical University, Clinic for Immunology and Rheumatology, Carl-Neubergstr. 1, 30625, Hannover, Germany.
| | - Anna Holz
- Hannover Medical University, Clinic for Immunology and Rheumatology, Carl-Neubergstr. 1, 30625, Hannover, Germany
| | - Elke Riechers
- Hannover Medical University, Clinic for Immunology and Rheumatology, Carl-Neubergstr. 1, 30625, Hannover, Germany
| | - Florian Länger
- Institute for Pathology, Hannover Medical University, Carl-Neubergstr. 1, 30625, Hannover, Germany
| | - Christian von Falck
- Institute for Diagnostic and Interventional Radiology, Hannover Medical University, Carl-Neubergstr. 1, 30625, Hannover, Germany
| | - Reinhold Ernst Schmidt
- Hannover Medical University, Clinic for Immunology and Rheumatology, Carl-Neubergstr. 1, 30625, Hannover, Germany
| | - Torsten Witte
- Hannover Medical University, Clinic for Immunology and Rheumatology, Carl-Neubergstr. 1, 30625, Hannover, Germany
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23
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Jemaa MB, Zribi W, Elleuch E, Bouaziz W, Abid A, Yaich S, Aoui M, Ayedi K, Jemaa MB, Zribi M, Keskes H. [Tuberculous bursitis of the shoulder in a patient with chronic renal insufficiency: about a case]. Pan Afr Med J 2018; 30:182. [PMID: 30455811 PMCID: PMC6235483 DOI: 10.11604/pamj.2018.30.182.12557] [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: 04/19/2017] [Accepted: 12/05/2017] [Indexed: 12/05/2022] Open
Abstract
La tuberculose de l'épaule est rare. Elle regroupe toutes les atteintes tuberculeuses des tissus articulaires et péri-articulaires de l'épaule. Son évolution insidieuse mimant les pathologies inflammatoires et dégénératives, explique la fréquence de son retard diagnostique. Nous rapportons un cas rare d'une bursite tuberculeuse de l'épaule chez une femme de milieu rural, insuffisante rénale et traitée pour une tuberculose péritonéale et du psoas. Des signes d'imprégnation tuberculeuse ont été notés à l'anamnèse. L'examen clinique trouvait une tuméfaction douloureuse de l'épaule avec raideur. L'IRM de l'épaule était en faveur d'une bursite infectieuse. L'origine tuberculeuse était confirmée par l'examen histologique d'une biopsie synoviale écho-guidée. Un traitement antituberculeux lui a été instauré avec bonne évolution. Au recul de 9 ans, elle retrouve une fonction articulaire satisfaisante avec absence de récidive infectieuse.
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Affiliation(s)
- Mohamed Ben Jemaa
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax,Tunisie
| | - Wassim Zribi
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax,Tunisie
| | - Emna Elleuch
- Service des Maladies Infectieuses, CHU Hédi Chaker de Sfax, Tunisie
| | - Wajdi Bouaziz
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax,Tunisie
| | - Ameur Abid
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax,Tunisie
| | - Soumaya Yaich
- Service de Néphrologie, CHU Hédi Chaker de Sfax,Tunisie
| | - Mourad Aoui
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax,Tunisie
| | - Kamel Ayedi
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax,Tunisie
| | - Mounir Ben Jemaa
- Service des Maladies Infectieuses, CHU Hédi Chaker de Sfax, Tunisie
| | - Mohamed Zribi
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax,Tunisie
| | - Hassib Keskes
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax,Tunisie
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Abstract
Musculoskeletal tuberculosis (TB) accounts for approximately 10% of all extrapulmonary TB cases in the United States and is the third most common site of extrapulmonary TB after pleural and lymphatic disease. Vertebral involvement (tuberculous spondylitis, or Pott's disease) is the most common type of skeletal TB, accounting for about half of all cases of musculoskeletal TB. The presentation of musculoskeletal TB may be insidious over a long period and the diagnosis may be elusive and delayed, as TB may not be the initial consideration in the differential diagnosis. Concomitant pulmonary involvement may not be present, thus confusing the diagnosis even further. Early diagnosis of bone and joint disease is important to minimize the risk of deformity and enhance outcome. The introduction of newer imaging modalities, including MRI (imaging procedure of choice) and CT, has enhanced the diagnostic evaluation of patients with musculoskeletal TB and for directed biopsies of affected areas of the musculoskeletal system. Obtaining appropriate specimens for culture and other diagnostic tests is essential to establish a definitive diagnosis and recover M. tuberculosis for susceptibility testing. A total of 6 to 9 months of a rifampin-based regimen, like treatment of pulmonary TB, is recommended for the treatment of drug susceptible musculoskeletal disease. Randomized trials of tuberculous spondylitis have demonstrated that such regimens are efficacious. These data and those from the treatment of pulmonary TB have been extrapolated to form the basis of treatment regimen recommendations for other forms of musculoskeletal TB.
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25
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Gambhir S, Ravina M, Rangan K, Dixit M, Barai S, Bomanji J. Imaging in extrapulmonary tuberculosis. Int J Infect Dis 2016; 56:237-247. [PMID: 27838445 DOI: 10.1016/j.ijid.2016.11.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 12/17/2022] Open
Abstract
Tuberculosis (TB) remains a major global public health problem, with 1.5 million deaths annually worldwide. One in five cases of TB present as extrapulmonary TB (EPTB), posing major diagnostic and management challenges. Mycobacterium tuberculosis adapts to a quiescent physiological state and is notable for its complex interaction with the host, producing poorly understood disease states ranging from latent infection to active clinical disease. New tools in the diagnostic armamentarium are urgently required for the rapid diagnosis of TB and monitoring of TB treatments, and to gain new insights into pathogenesis. The typical and atypical imaging features of EPTB are reviewed herein, and the roles of several imaging modalities for the diagnosis and management of EPTB are discussed.
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Affiliation(s)
- Sanjay Gambhir
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India.
| | - Mudalsha Ravina
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India
| | - Kasturi Rangan
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India
| | - Manish Dixit
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India
| | - Sukanta Barai
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India
| | - Jamshed Bomanji
- Department of Nuclear Medicine, of Nuclear Medicine, UCLH NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK.
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Brea Álvarez B, Tuñón Gómez M, Esteban García L, García Hidalgo C, Ruiz Peralbo R. Nontraumatic head and neck emergencies: A clinical approach. Part 1: Cervicofacial swelling, dysphagia, and dyspnea. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nontraumatic head and neck emergencies: a clinical approach. Part 1: cervicofacial swelling, dysphagia, and dyspnea. RADIOLOGIA 2016; 58:329-42. [PMID: 27520826 DOI: 10.1016/j.rx.2016.06.012] [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: 11/29/2015] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 11/23/2022]
Abstract
Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons: first, they affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known. Various publications focus on nontraumatic emergencies of the head and neck from the viewpoints of anatomic location or of particular diseases. However, these are not the most helpful viewpoints for dealing with patients in the emergency department, who present with particular signs and symptoms. We propose an analysis starting from the four most common clinical presentations of patients who come to the emergency department for nontraumatic head and neck emergencies: cervical swelling, dysphagia, dyspnea, and loss of vision. Starting from these entities, we develop an approach to the radiologic management and diagnosis of these patients.
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Miladi S, Dhahri R, Hamdi W, Kaffel D, Abid L, Farah F, Kchir MM. Wrist synovectomy confirmed tuberculous tenosynovitis in 8 cases: A follow-up study. THE EGYPTIAN RHEUMATOLOGIST 2016. [DOI: 10.1016/j.ejr.2016.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Raut AA, Naphade PS, Ramakantan R. Imaging Spectrum of Extrathoracic Tuberculosis. Radiol Clin North Am 2016; 54:475-501. [DOI: 10.1016/j.rcl.2015.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Korim M, Patel R, Allen P, Mangwani J. Foot and ankle tuberculosis: case series and literature review. Foot (Edinb) 2014; 24:176-9. [PMID: 25178156 DOI: 10.1016/j.foot.2014.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/13/2014] [Accepted: 07/16/2014] [Indexed: 02/04/2023]
Abstract
Foot and ankle tuberculosis (TB) is a rare presentation of skeletal TB. The uncommon site along with low index of clinical suspicion in the western world leads to delays in the diagnosis and treatment. This can make joint sparing procedures less successful, especially in the midfoot where the joints can often be interconnected. Plain radiographs have low sensitivity and specificity and cross sectional imaging in the form of MRI or CT is more reliable. Treatment involves the use of multiple anti-tuberculous drugs in the first instance, followed by surgery to address any symptomatic deformity and/or secondary degenerative changes. We present our experience on the management of this rare problem and review the literature on the clinical presentation, diagnosis, imaging modalities and treatment.
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Affiliation(s)
- Muhammad Korim
- University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom.
| | - Rizwan Patel
- University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
| | - Patricia Allen
- University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
| | - Jitendra Mangwani
- University Hospitals Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
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Abstract
Focal lesions in bone are very common and many of these lesions are not bone tumors. These bone tumor mimickers can include numerous normal anatomic variants and non-neoplastic processes. Many of these tumor mimickers can be left alone, while others can be due to a significant disease process. It is important for the radiologist and clinician to be aware of these bone tumor mimickers and understand the characteristic features which allow discrimination between them and true neoplasms in order to avoid unnecessary additional workup. Knowing which lesions to leave alone or which ones require workup can prevent misdiagnosis and reduce patient anxiety.
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Affiliation(s)
- Jennifer Ni Mhuircheartaigh
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Yu-Ching Lin
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States ; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung Chang Gung University, Taoyuan, Taiwan
| | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
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Affiliation(s)
- K-L Lai
- Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan
| | - Z-Y Shi
- Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan
| | - W-C Chao
- Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan
| | - P-Y Liu
- Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan
| | - L-H Wu
- Department of Internal Medicine, Dongyang People's Hospital, Dongyang, Zhejiang, China.
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33
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Hertting O, Shingadia D. Childhood TB: when to think of it and what to do when you do. J Infect 2013; 68 Suppl 1:S151-4. [PMID: 24119929 DOI: 10.1016/j.jinf.2013.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 11/18/2022]
Abstract
Although childhood tuberculosis has declined dramatically in the UK over the last century, it is now increasing again and globally childhood tuberculosis still accounts for a significant proportion of the tuberculosis disease burden. Children may present with non-specific symptoms, and because of the paucibacillary nature of disease and the difficulty of producing sputum samples, tuberculosis in children is often difficult to diagnose. Apart from the traditional diagnostic methods, like chest X-ray, tuberculin skin testing and mycobacterial staining or culture, new diagnostic strategies have been developed. In particular, immune-based diagnostics, such as interferon-gamma release assays, have now been introduced for clinical use. However these tests do not offer substantial improvements in sensitivity over tuberculin skin testing for the diagnosis of active disease. Further research is needed to develop better diagnostic tests for tuberculosis in children.
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Affiliation(s)
- Olof Hertting
- Department of Emergency Pediatrics & Infectious Disease, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
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34
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Updated diagnosis and treatment of childhood tuberculosis. World J Pediatr 2013; 9:9-16. [PMID: 23389330 DOI: 10.1007/s12519-013-0404-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Childhood tuberculosis (TB) accounts for a significant proportion of the global tuberculosis disease burden. However, current and previous efforts to develop better diagnostic, therapeutic, and preventive interventions have focused on TB in adults, and childhood TB has been relatively neglected. The purpose of this review is to provide an update on the diagnostic and therapeutic recommendations for childhood TB with an emphasis on intrathoracic disease. DATA SOURCES The literature from a range of sources was reviewed and synthesized to provide an overview of the contemporary approaches for the diagnosis and treatment of childhood TB. RESULTS This review summarizes the clinical, radiological, bacteriological, and immunological approaches to diagnose TB infection and disease in children. In addition, we summarize the updated guidelines for the treatment of TB in children. CONCLUSIONS The development of better diagnostic and therapeutic methods for childhood TB remains a significant challenge. As the strategies for diagnosis and treatment of childhood TB continue to improve and the knowledge base increases, the implementation of these strategies will be crucial.
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Imaging features of pediatric musculoskeletal tuberculosis. Pediatr Radiol 2012; 42:1235-49. [PMID: 22735926 DOI: 10.1007/s00247-012-2439-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 04/29/2012] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
Abstract
Tuberculosis (TB) is widely prevalent in developing nations and has recently made a comeback in industrialized countries, with the rise in immunocompromized patients. Musculoskeletal TB in children presents a diagnostic challenge because it is difficult to recognize in the early stages of the disease, and imaging features mimic other entities. The clinical onset is insidious, with an indolent course and a resultant late presentation. It leads to significant morbidity; a delay in diagnosis can cause potentially serious neurological complications and bone and joint destruction. Conventional radiographs are the initial imaging modality and US, CT and MRI are used in conjunction to better delineate the disease extent and morphology. Radiologists should be familiar with the spectrum of imaging features of TB, including plain radiographs and MRI, and aid the clinician in making an early diagnosis. Aspiration or biopsy with examination for acid-fast bacillus and histological evaluation is required to confirm the diagnosis.
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Abstract
Childhood tuberculosis accounts for a significant proportion of the global tuberculosis disease burden. However, tuberculosis in children is difficult to diagnose, because disease tends to be paucibacillary and sputum samples are often not easy to obtain. The diagnosis of tuberculosis in children is traditionally based on chest radiography, tuberculin skin testing, and mycobacterial staining/culture from appropriate samples. Newer diagnostic strategies have included improved bacteriologic and molecular methods, as well as new methods for sample collection from children. Recently, immune-based diagnostics, such as the interferon-gamma release assays, have been introduced for clinical use. These tests do not offer substantial improvements in sensitivity over tuberculin skin testing for the diagnosis of active disease but may be useful in excluding false-positive tuberculin skin tests. Further research is needed to develop better diagnostic tests for tuberculosis in children.
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37
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Abstract
There has been a recent global resurgence of tuberculosis (TB) fuelled by HIV infection and migration. Childhood TB represents a sentinel event in the community, suggesting recent transmission from an infectious adult. The diagnosis of TB in children is based on chest X-ray, tuberculin skin testing and mycobacterial staining/culture, although the diagnostic yield from these investigations is often lower than in adults. Newer diagnostic tests are being developed and may improve the diagnostic yield in childhood TB. Treatment of TB in children is similar to adults in that short-course multidrug treatment has been adopted as standard therapy in many national TB programmes. Compliance is a major determinant of the success of drug treatment and directly observed therapy has been adopted as a key component of TB treatment programmes. Although uncommon in children, multidrug-resistant TB is also increasing and treatment often involves longer courses of therapy with second-line drugs.
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Affiliation(s)
- Delane Shingadia
- Department of Infectious Diseases, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK
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38
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Go SW, Lee HY, Lim CH, Jee WH, Wang YP, Yoo IR, Kang JY. Atypical disseminated skeletal tuberculosis mimicking metastasis on PET-CT and MRI. Intern Med 2012; 51:2961-5. [PMID: 23064577 DOI: 10.2169/internalmedicine.51.8347] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Multifocal skeletal tuberculosis is a very rare manifestation of tuberculous infection. The multiple bone lesions of multifocal skeletal tuberculosis are difficult to differentiate from metastasis, even when performing 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (FDG PET/CT) or magnetic resonance imaging (MRI). A 25-year-old man presented with an abnormal chest X-ray. Radiologically, there were extensive osteolytic lesions on the skull, along the entire spine and on the ribs and both iliac bones, suggesting a diagnosis of bone metastasis. On FDG PET/CT, intensely increased F-18 FDG lesions were observed. A bone biopsy with a microbiologic study revealed a tuberculous infection. Follow-up PET/CT performed after treatment showed marked improvement in the extensive FDG uptake lesions.
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Affiliation(s)
- Seong Woo Go
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Korea
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39
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Bony sequestrum: a radiologic review. Skeletal Radiol 2011; 40:963-75. [PMID: 20571796 DOI: 10.1007/s00256-010-0975-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 04/21/2010] [Accepted: 05/14/2010] [Indexed: 02/02/2023]
Abstract
According to a pathological definition, a bony sequestrum is defined as a piece of devitalized bone that has been separated from the surrounding bone during the process of necrosis. However, the radiological definition of a sequestrum is different and refers to an image of calcification visible within a lucent lesion, completely separated from the surrounding bone, without referring to the vascular status and histological nature of the calcified tissue. The term "button sequestrum" has been used in calvarial lesions. The prototype conditions that may present with a bony sequestrum are osteomyelitis and skeletal tuberculosis. Other conditions such as radiation necrosis, eosinophilic granuloma, metastatic carcinoma, primary lymphoma of bone, aggressive fibrous tumors may also manifest as osteolytic lesions containing a sequestrum. In addition, some primary bone tumors produce a matrix that may mineralize and sometimes simulate a bone sequestrum. These include osteoid tumors (osteoid osteoma, osteoblastoma), cartilaginous tumors (chondroma and chondroblastoma), lipomatous tumors (lipoma), and benign fibrous tumors (fibromyxoma, myxoma, and desmoplastic fibroma). Therefore, various conditions may present at imaging as a small area of osteolysis containing central calcifications. However, a careful analysis of the sequestrum as well as the associated clinical and radiological findings often enables to point toward a limited number of conditions.
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40
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De Backer AI, Vanhoenacker FM, Sanghvi DA. Imaging features of extraaxial musculoskeletal tuberculosis. Indian J Radiol Imaging 2011; 19:176-86. [PMID: 19881081 PMCID: PMC2766888 DOI: 10.4103/0971-3026.54873] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tuberculosis (TB) continues to be a public health problem in both developing and industrialized countries. TB can involve pulmonary as well as extrapulmonary sites. The musculoskeletal system is involved in 1–3% of patients with tuberculosis. Although musculoskeletal TB has become uncommon in the Western world, it remains a huge problem in Asia, Africa, and many developing countries. Tuberculous spondylitis is the most common form of musculoskeletal TB and accounts for approximately 50% of cases. Extraspinal musculoskeletal TB shows a predilection for large joints (hip and knee) and para-articular areas; isolated soft tissue TB is extremely rare. Early diagnosis and prompt treatment are mandatory to prevent serious destruction of joints and skeletal deformity. However, due to the nonspecific and often indolent clinical presentation, the diagnosis may be delayed. Radiological assessment is often the first step in the diagnostic workup of patients with musculoskeletal TB and further investigations are decided by the findings on radiography. Both the radiologist and the clinician should be aware of the possibility of this diagnosis. In this manuscript we review the imaging features of extraspinal bone, joint, and soft tissue TB.
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Affiliation(s)
- Adelard I De Backer
- Department of Radiology, Antwerp University Hospital, UZA, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem and Department of Radiology, AZ Sint-Maarten, Duffel-Mechelen, Rooienberg 25, B-2570 Duffel, Belgium
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41
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Samuel S, Boopalan PRJVC, Alexander M, Ismavel R, Varghese VD, Mathai T. Tuberculosis of and around the ankle. J Foot Ankle Surg 2011; 50:466-72. [PMID: 21612948 DOI: 10.1053/j.jfas.2011.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Indexed: 02/03/2023]
Abstract
Osteoarticular tuberculosis of the ankle joint is rare, and diagnostic delays are common with this condition. The aim of our report is to highlight the varied clinical and radiologic presentation of this entity. We present a retrospective review of 16 patients with tuberculosis in and around the ankle joint who were surgically treated during a 6-year period. The incidence of ankle joint involvement in extraspinal osteoarticular tuberculosis was 15.7% in our unit. The most common presentation in our series was chronic septic arthritis, followed by periarticular osseous lytic lesion. Tuberculous synovitis, tenosynovits, and retrocalcaneal bursitis were also seen. Osteopenia, the hallmark of osteoarticular tuberculosis, might not be seen in all forms of tuberculosis affecting this joint. Chemotherapy remains the mainstay of treatment. Adjuvant surgery is often required to establish the diagnosis and in the treatment of patients with deformity and widespread destruction of articular cartilage owing to delayed presentation.
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Affiliation(s)
- Sumant Samuel
- Department of Orthopaedics (Unit III), Christian Medical College, Vellore, TN, India.
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42
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Andronikou S, Bindapersad M, Govender N, Waner JI, Segwe A, Palliam S, Shenxane O, Mngomezulu V. Musculoskeletal tuberculosis - imaging using low-end and advanced modalities for developing and developed countries. Acta Radiol 2011; 52:430-41. [PMID: 21498288 DOI: 10.1258/ar.2011.100444] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Musculoskeletal involvement by TB is rare in comparison to other forms of the disease. It most commonly involves the spine but can also involve large weight-bearing joints, long bones, the skull and the soft tissues. Characteristic appearances of musculoskeletal TB are described for numerous imaging modalities in this paper but it is also highlighted that when based on imaging appearances alone, there is always a differential diagnosis, including other infections and malignancies. Awareness of of TB as a possible cause of vertebral body lesions, arthritis and synovitis, long bone lesions and soft tissue collections will allow clinicians to consider TB based on imaging and will sometimes be characteristic enough to allow for a trial of therapy, thereby avoiding biopsy. This paper specifically describes the imaging appearances on both basic modalities such as plain radiographs and ultrasound for those working in resource-restricted areas, as well as on high-end modalities such as CT and MRI for those with access to these. Tuberculosis is no longer a disease limited to the developing world and radiologists in the developed world must be able to make this diagnosis in both immigrants and the native population.
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Affiliation(s)
- Savvas Andronikou
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Manitha Bindapersad
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Nishentha Govender
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan I Waner
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Aobakwe Segwe
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Samantha Palliam
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Odwa Shenxane
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Mngomezulu
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
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44
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Old enemy on a difficult terrain: tuberculosis in rheumatology practice with focus on uncommon extrapulmonary affection. INDIAN JOURNAL OF RHEUMATOLOGY 2011. [DOI: 10.1016/s0973-3698(11)60030-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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45
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Dolor cervical y astenia: tuberculosis de una localización inusual. Rev Clin Esp 2010; 210:e33-5. [DOI: 10.1016/j.rce.2010.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 04/14/2010] [Indexed: 11/19/2022]
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Kwon HH, Baek SH, Park SH. Miliary tuberculosis and necrotizing tuberculous fasciitis--an unusual coexistence in a rheumatoid arthritis patient. Int J Rheum Dis 2010; 13:171-4. [PMID: 20536603 DOI: 10.1111/j.1756-185x.2010.01467.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of a 65-year-old Korean female patient with rheumatoid arthritis, who presented with extensive necrotizing fasciitis of the gluteus muscles, as an unusual initial manifestation of miliary tuberculosis. The patient had been previously treated with conventional disease-modifying antirheumatic drugs and low-dose steroids for 7 years. However, she recently developed fever, warmth and painful swelling in her right buttock. Magnetic resonance imaging indicated necrotizing fasciitis of the gluteus muscles and a fasciectomy specimen revealed a Mycobacterium tuberculosis infection. Two weeks after a fasciectomy, miliary tuberculosis of the lung was diagnosed by high resolution chest computed tomography. Soft tissue infection due to M. tuberculosis should be included as a differential diagnosis in the immunocompromised host. Clinicians should be alert to the possibility of miliary tuberculosis even in the absence of respiratory symptoms and normal chest radiograph.
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Affiliation(s)
- Hyun-Hee Kwon
- Department of Internal Medicine, Catholic University of Daegu, School of Medicine, Daegu, Korea
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47
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Choi SW, Ahn JJ, Hwang YT, Koh SH, Cho SD. A case of tuberculous arthritis following the use of etanercept. Korean J Intern Med 2009; 24:397-401. [PMID: 19949742 PMCID: PMC2784987 DOI: 10.3904/kjim.2009.24.4.397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Accepted: 08/09/2007] [Indexed: 11/27/2022] Open
Abstract
Etanercept is a tumor necrosis factor (TNF) inhibitor that has been used for the treatment of chronic inflammatory diseases including rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Because of its immunosuppressive activity, opportunistic infections have been noted in treated patients, most notably caused by Mycobacterium tuberculosis. Tuberculosis may present in an extrapulmonary or disseminated form. Since TNF-alpha inhibitors have been used in Korea, a few cases of TNF-alpha inhibitor associated tuberculosis have been described. However, tuberculous arthritis has not been previously reported. We describe a case of tuberculous arthritis in a 57-year-old woman with rheumatoid arthritis who was treated with etanercept.
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Affiliation(s)
- Seung Won Choi
- Department of Internal Medicin, Ulsan University Hospital, Ulsan University College of Medicine, Dong-gu, Ulsan, Korea.
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48
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Neogi DS, Jain S, Mishra KK, Trikha V, Nag HL. An unusual cause of Wartenberg’s syndrome: tuberculosis of brachioradialis muscle. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2009. [DOI: 10.1007/s00590-009-0569-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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50
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Gardner-Medwin JMM, Irwin G, Johnson K. MRI in juvenile idiopathic arthritis and juvenile dermatomyositis. Ann N Y Acad Sci 2009; 1154:52-83. [PMID: 19250231 DOI: 10.1111/j.1749-6632.2009.04498.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The use of MRI in the assessment of the musculoskeletal system in children has important differences from its use in adults. Growth in children has significant impact on the epiphysis and growth plate, which are important structures in the growing child, and there are radiological features that differ from those in adults: disease may alter structures during a period of growth; the pathologies themselves are a distinct group of diseases at variance with adult arthritis and myositis, with a different spectrum of differential diagnoses; and many technical issues are different when imaging a child. These are important considerations in choosing the appropriate imaging. MRI is a powerful and valuable imaging technique in pediatric musculoskeletal pathologies, with considerable potential for future developments to enhance its role in diagnosis, management, and therapeutic intervention for these children.
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